Healthcare Provider Details

I. General information

NPI: 1437723277
Provider Name (Legal Business Name): MAGDALENA WIECZOREK PMNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ALBANY TPKE # 1036
WEST SIMSBURY CT
06092-2903
US

IV. Provider business mailing address

14 RYANS WAY
BURLINGTON CT
06013-1822
US

V. Phone/Fax

Practice location:
  • Phone: 860-518-7569
  • Fax: 860-453-6464
Mailing address:
  • Phone: 860-539-7538
  • Fax: 860-453-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number9672
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: