Provider Demographics
NPI:1750540001
Name:STANISLAW P. CHORZEPA, D.O., LLC
Entity type:Organization
Organization Name:STANISLAW P. CHORZEPA, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANINA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CHORZEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-893-0300
Mailing Address - Street 1:211 NEW BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1360
Mailing Address - Country:US
Mailing Address - Phone:860-893-0300
Mailing Address - Fax:860-893-0301
Practice Address - Street 1:211 NEW BRITAIN RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1360
Practice Address - Country:US
Practice Address - Phone:860-893-0300
Practice Address - Fax:860-893-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1750375127OtherINDIVIDUAL NPI