Provider Demographics
NPI:1598864217
Name:PIEKARZ-DYJAK, ELZBIETA (MD)
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:
Last Name:PIEKARZ-DYJAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MAIN ST FL 2
Mailing Address - Street 2:COMMUNITY HEALTH CENTER, INC.
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2845
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:
Practice Address - Street 1:85 LAFAYETTE STREET
Practice Address - Street 2:COMMUNITY HEALTH CENTER, INC.
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-224-3642
Practice Address - Fax:860-224-2760
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017640207Q00000X
CT046455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008004591Medicaid
CT004236346Medicaid
CTD400014137Medicare PIN