Healthcare Provider Details

I. General information

NPI: 1215909072
Provider Name (Legal Business Name): JONATHAN THOMAS PUCHALSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GOOSE LN STE 203B
GUILFORD CT
06437-2492
US

IV. Provider business mailing address

350 GOOSE LN STE 203B
GUILFORD CT
06437-2492
US

V. Phone/Fax

Practice location:
  • Phone: 203-738-7700
  • Fax: 203-689-6500
Mailing address:
  • Phone: 203-738-7700
  • Fax: 203-689-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number047218
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number047218
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35077075
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD432420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: