Healthcare Provider Details

I. General information

NPI: 1316979750
Provider Name (Legal Business Name): JOHN JOSEPH GEVINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 W MAIN ST
WATERBURY CT
06708-2651
US

IV. Provider business mailing address

1078 W MAIN ST
WATERBURY CT
06708-2651
US

V. Phone/Fax

Practice location:
  • Phone: 203-754-3100
  • Fax:
Mailing address:
  • Phone: 203-754-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number032217
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number032217
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: