Provider Demographics
NPI:1528399763
Name:OZIMEK, DAVID L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:OZIMEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HAZARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4520
Mailing Address - Country:US
Mailing Address - Phone:860-763-7668
Mailing Address - Fax:860-763-7676
Practice Address - Street 1:140 HAZARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4520
Practice Address - Country:US
Practice Address - Phone:860-763-7668
Practice Address - Fax:860-763-7676
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant