Provider Demographics
NPI:1013395490
Name:GORECKA, JOLANTA JUSTYNA (MD)
Entity Type:Individual
Prefix:MS
First Name:JOLANTA
Middle Name:JUSTYNA
Last Name:GORECKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 STATE ST
Mailing Address - Street 2:APT 2703
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3601
Mailing Address - Country:US
Mailing Address - Phone:201-835-3830
Mailing Address - Fax:
Practice Address - Street 1:330 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program