Provider Demographics
NPI:1710937172
Name:UCONN HEALTH CENTER ANESTHESIOLOGY
Entity Type:Organization
Organization Name:UCONN HEALTH CENTER ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:MS
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-282-4137
Mailing Address - Street 1:99 E RIVER DR
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004219334Medicaid
CT004219839OtherAPRN GROUP CT MEDICAID
CT004219334Medicaid