MEDICARE: RONALD S. JURZYK MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	035267	CT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00083127	OTHER	CT	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01035267	OTHER	CT	CIGNA
2	113666656	OTHER	CT	UNITED HEALTHCARE
3	010035267CT01	OTHER	CT	ANTHEM BLUE CROSS
4	035267	OTHER	CT	CONNECTICARE
5	0706312	OTHER	CT	AETNA
7	270791	OTHER	CO	WELLCARE
8	2V2970	OTHER	CT	HEALTHNET
9	270791	OTHER	CT	WELLCARE
10	P437247	OTHER	CT	OXFORD

NPI Number	:	1215910922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD S. JURZYK MD

Provider Business Mailing Address
First Line	:	464 WOLCOTT RD
Second Line	:
City	:	WOLCOTT
State	:	CT
Zip	:	06716-2626
Country	:	US
Telephone Number	:	203-879-6171
Fax Number	:	203-879-1191

Provider Business Practice Location Address
First Line	:	464 WOLCOTT RD
Second Line	:
City	:	WOLCOTT
State	:	CT
Zip	:	06716-2626
Country	:	US
Telephone Number	:	203-879-6171
Fax Number	:	203-879-1191

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	01/11/2010

464 WOLCOTT RD , GERICARE, LLC
WOLCOTT, CT
06716-2626

Practice Phone: 203-633-4560
Practice Fax: 203-926-0594