Healthcare Provider Details

I. General information

NPI: 1285875419
Provider Name (Legal Business Name): MARGRET ZAJAC BAKER RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMERCE PARK
MILFORD CT
06460-3511
US

IV. Provider business mailing address

1 CHURCH ST 4TH FLOOR
NEW HAVEN CT
06510-3330
US

V. Phone/Fax

Practice location:
  • Phone: 203-301-5401
  • Fax: 203-877-7165
Mailing address:
  • Phone: 203-752-3200
  • Fax: 203-752-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number002095
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: