Provider Demographics
NPI:1306851050
Name:DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT, PC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZALKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-792-4151
Mailing Address - Street 1:170 MOUNT PLEASANT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1408
Mailing Address - Country:US
Mailing Address - Phone:203-792-4151
Mailing Address - Fax:203-792-4155
Practice Address - Street 1:170 MOUNT PLEASANT RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1408
Practice Address - Country:US
Practice Address - Phone:203-792-4151
Practice Address - Fax:203-792-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00193Medicare ID - Type UnspecifiedMEDICARE CLINIC #