Provider Demographics
NPI:1093866626
Name:STRAZNICKY, PAVEL (MD)
Entity Type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:STRAZNICKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MERIDEN AVE
Mailing Address - Street 2:3E
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3238
Mailing Address - Country:US
Mailing Address - Phone:860-628-2046
Mailing Address - Fax:860-628-8154
Practice Address - Street 1:291 FRANKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2849
Practice Address - Country:US
Practice Address - Phone:201-847-0119
Practice Address - Fax:201-847-0871
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04351800174400000X
CT025000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61963Medicare UPIN
02000489Medicare ID - Type Unspecified