MEDICARE: FREDERICK GLUSZEK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	94738	CT

General Provider Information

NPI Number	:	1063982791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK GLUSZEK CRNA

Provider Business Mailing Address
First Line	:	99 EAST RIVER DRIVE
Second Line	:	5TH FLOOR
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108
Country	:	US
Telephone Number	:	860-282-0833
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 SEYMOUR STREET
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06108-7301
Country	:	US
Telephone Number	:	860-545-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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