Provider Demographics
NPI:1720236367
Name:JOHN P. NOWICKI M.D. P.C.
Entity Type:Organization
Organization Name:JOHN P. NOWICKI M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-874-0248
Mailing Address - Street 1:2044 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4633
Mailing Address - Country:US
Mailing Address - Phone:203-874-0248
Mailing Address - Fax:203-874-7504
Practice Address - Street 1:2044 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4633
Practice Address - Country:US
Practice Address - Phone:203-874-0248
Practice Address - Fax:203-874-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019703CT207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000384OtherHEALTH NET OF CONNECTICUT
CT001197037Medicaid
CT010019703CT01OtherANTHEM BLUE CROSS AND BLUE SHIELD
CT110000890Medicare PIN
CTB84456Medicare UPIN