Provider Demographics
NPI:1669995247
Name:OKSANA KLOYZNER,MD LLC
Entity type:Organization
Organization Name:OKSANA KLOYZNER,MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOYZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-242-4000
Mailing Address - Street 1:701 COTTAGE GROVE RD STE F
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 COTTAGE GROVE RD STE F
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3080
Practice Address - Country:US
Practice Address - Phone:860-242-4000
Practice Address - Fax:860-243-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001397654Medicaid