Healthcare Provider Details

I. General information

NPI: 1669527982
Provider Name (Legal Business Name): PAUL ROBERT PARKOSEWICH P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

24 STEVENS ST
NORWALK CT
06850-3852
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2016
  • Fax: 203-855-3596
Mailing address:
  • Phone: 203-852-2016
  • Fax: 203-855-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000514
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: