Provider Demographics
NPI:1689600561
Name:KOLODZIEJCZAK, LESZEK A (MD)
Entity Type:Individual
Prefix:MR
First Name:LESZEK
Middle Name:A
Last Name:KOLODZIEJCZAK
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 FOUNDERS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2050
Mailing Address - Country:US
Mailing Address - Phone:860-423-5000
Mailing Address - Fax:
Practice Address - Street 1:162 MANSFIELD AVE.
Practice Address - Street 2:B
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226
Practice Address - Country:US
Practice Address - Phone:860-423-5000
Practice Address - Fax:860-423-4838
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032557208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010032557CT01OtherANTHEM BC / BS
CT030946OtherHEALTHNET
CT001325572Medicaid
CT001325572OtherBLUE CARE FAMILY PLAN
CT0811232OtherAETNA / US HEALTHCARE
CT9079072002OtherCIGNA
CTP469467OtherOXFORD
CTP04569OtherCHN
CT767225OtherCONNECTICARE
CTP04569OtherCHN
CT030946OtherHEALTHNET
CTG26575Medicare UPIN