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General NPI Number Information
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NPI Number | 1336847003
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Entity Type | Individual
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Provider Name | DAVID MISIASZEK NP
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Gender | Male
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 480 FITCHVILLE RD
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City | GILMAN
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State | CT
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Zip | 06336-1000
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Country | US
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Telephone | 860-961-4923
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Fax |
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Provider Business Mailing Address
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Address Line | 480 FITCHVILLE RD
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City | GILMAN
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State | CT
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Zip | 06336-1000
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Country | US
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Telephone | 860-961-4923
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | E55459
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11670
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License Number State | CT
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