Provider Demographics
NPI:1669460176
Name:BRAKONIECKI, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:BRAKONIECKI
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 1:99 E RIVER DR
Mailing Address - Street 2:#300 C/O IPMS
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3288
Mailing Address - Country:US
Mailing Address - Phone:860-282-4137
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:99 E RIVER DR
Practice Address - Street 2:#300 C/O IPMS
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3288
Practice Address - Country:US
Practice Address - Phone:860-282-4137
Practice Address - Fax:860-289-0742
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026301207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001263011Medicaid
CT050001135Medicare ID - Type Unspecified
CT001263011Medicaid