Provider Demographics
NPI:1205808417
Name:KONIK, DOREEN (MD)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:KONIK
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 1:11 OLD PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2507
Mailing Address - Country:US
Mailing Address - Phone:860-355-1149
Mailing Address - Fax:860-355-5957
Practice Address - Street 1:11 OLD PARK LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-1149
Practice Address - Fax:860-355-5957
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010042886CT01OtherANTHEM BC/BS
CT2V7088OtherACS/HEALTHNET
CT001428863Medicaid
CTP3597904OtherOXFORD
CT4300290OtherAETNA/USHC
CT042886OtherCONNECTICARE