Healthcare Provider Details

I. General information

NPI: 1174877971
Provider Name (Legal Business Name): MAGDALENA LUKASZEWICZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CEDAR ST
NEW BRITAIN CT
06052-1301
US

IV. Provider business mailing address

1 LIBERTY SQ
NEW BRITAIN CT
06051-2636
US

V. Phone/Fax

Practice location:
  • Phone: 860-229-8346
  • Fax:
Mailing address:
  • Phone: 860-827-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002834
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: