Provider Demographics
NPI:1437852407
Name:MOKRYTZKI, SLAKE (MD)
Entity Type:Individual
Prefix:
First Name:SLAKE
Middle Name:
Last Name:MOKRYTZKI
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 1:5 PERRYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4697
Mailing Address - Country:US
Mailing Address - Phone:203-863-3911
Mailing Address - Fax:203-863-3924
Practice Address - Street 1:5 PERRYRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4697
Practice Address - Country:US
Practice Address - Phone:203-863-3911
Practice Address - Fax:203-863-3924
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program