Healthcare Provider Details

I. General information

NPI: 1144505967
Provider Name (Legal Business Name): MONYA A ZURKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 COURT ST
MIDDLETOWN CT
06457-3302
US

IV. Provider business mailing address

196 COURT ST
MIDDLETOWN CT
06457-3302
US

V. Phone/Fax

Practice location:
  • Phone: 860-343-5510
  • Fax: 860-343-5507
Mailing address:
  • Phone: 860-343-5510
  • Fax: 860-343-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: