Provider Demographics
NPI:1760553481
Name:MROCZKA, ZOFIA S (MD)
Entity Type:Individual
Prefix:
First Name:ZOFIA
Middle Name:S
Last Name:MROCZKA
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:P.O. BOX 219
Mailing Address - Street 2:772 QUINEBAUG RD RT 131
Mailing Address - City:QUINEBAUG
Mailing Address - State:CT
Mailing Address - Zip Code:06262
Mailing Address - Country:US
Mailing Address - Phone:860-935-9273
Mailing Address - Fax:860-935-9087
Practice Address - Street 1:772 QUINEBAUG RD
Practice Address - Street 2:ROUTE 131
Practice Address - City:QUINEBAUG
Practice Address - State:CT
Practice Address - Zip Code:06262
Practice Address - Country:US
Practice Address - Phone:860-935-9273
Practice Address - Fax:860-935-9087
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1590822084N0400X
CT00403282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA983771Medicaid
J22893OtherBLUE CROSS
MADO1403287Medicaid
MA0104311Medicaid
0836203002OtherCIGNA
CT130000585Medicare ID - Type Unspecified
MADO1403287Medicaid
MAH23990Medicare UPIN
H23990Medicare UPIN
MAA31543Medicare PIN
A31563Medicare UPIN