Provider Demographics
NPI:1962656314
Name:SALEK, JEFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFREY
Middle Name:
Last Name:SALEK
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 1:79 WAWECUS ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2173
Mailing Address - Country:US
Mailing Address - Phone:860-886-2655
Mailing Address - Fax:860-887-9003
Practice Address - Street 1:79 WAWECUS ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2173
Practice Address - Country:US
Practice Address - Phone:860-886-2655
Practice Address - Fax:860-887-9003
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050701207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010050701CT01OtherANTHEM BLUE CROSS BLUE SHIELD OF CT
CTP4569410OtherOXFORD UNITED HEALTHCARE
CT507010OtherCONNECTICARE
CT5064741OtherCIGNA
CT5064741OtherCIGNA