Provider Demographics
NPI:1326324922
Name:KRUBITSKI, PAVEL
Entity Type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:KRUBITSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1505
Mailing Address - Country:US
Mailing Address - Phone:860-233-2346
Mailing Address - Fax:860-236-3607
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1505
Practice Address - Country:US
Practice Address - Phone:860-233-2346
Practice Address - Fax:860-236-3607
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001543156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician