Provider Demographics
NPI:1114928827
Name:SPECIALISTS IN WOMEN'S HEALTHCARE PC
Entity Type:Organization
Organization Name:SPECIALISTS IN WOMEN'S HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:KACZMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-754-2535
Mailing Address - Street 1:134 GRANDVIEW AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2507
Mailing Address - Country:US
Mailing Address - Phone:203-754-2535
Mailing Address - Fax:203-754-0788
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:STE 210
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2507
Practice Address - Country:US
Practice Address - Phone:203-754-2535
Practice Address - Fax:203-754-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004190310Medicaid
CTC02361Medicare PIN