=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215909072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN THOMAS PUCHALSKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 07/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 GOOSE LN STE 203B
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437-2492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-738-7700
-----------------------------------------------------
Fax | 203-689-6500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 GOOSE LN STE 203B
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437-2492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-738-7700
-----------------------------------------------------
Fax | 203-689-6500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 35077075
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | MD432420
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 047218
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 047218
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------