Provider Demographics
NPI:1003240409
Name:MARCZYK, VERONIKA (RD)
Entity type:Individual
Prefix:
First Name:VERONIKA
Middle Name:
Last Name:MARCZYK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1919
Mailing Address - Country:US
Mailing Address - Phone:860-305-0471
Mailing Address - Fax:860-948-9478
Practice Address - Street 1:356 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1919
Practice Address - Country:US
Practice Address - Phone:860-305-0471
Practice Address - Fax:860-948-9478
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1094386133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered