Healthcare Provider Details

I. General information

NPI: 1780478685
Provider Name (Legal Business Name): SUMMER BLUE PIWOWARSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ELM ST
NEW MILFORD CT
06776-2915
US

IV. Provider business mailing address

30 CROSBY ST APT 316
DANBURY CT
06810-5163
US

V. Phone/Fax

Practice location:
  • Phone: 860-210-5044
  • Fax:
Mailing address:
  • Phone: 207-418-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: