Healthcare Provider Details

I. General information

NPI: 1679728315
Provider Name (Legal Business Name): JENNIFER L ZAPATKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L KOWALCZUK PA-C

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVE SUITE M2-300
TRUMBULL CT
06611-3463
US

IV. Provider business mailing address

5520 PARK AVE SUITE M2-300
TRUMBULL CT
06611-3463
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-0310
  • Fax:
Mailing address:
  • Phone: 203-374-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3903
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002176
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: