Provider Demographics
NPI:1750375127
Name:CHORZEPA, STANISLAW PIOTR (DO)
Entity type:Individual
Prefix:DR
First Name:STANISLAW
Middle Name:PIOTR
Last Name:CHORZEPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NEW BRITAIN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1360
Mailing Address - Country:US
Mailing Address - Phone:860-893-0300
Mailing Address - Fax:860-893-0301
Practice Address - Street 1:211 NEW BRITAIN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1360
Practice Address - Country:US
Practice Address - Phone:860-893-0300
Practice Address - Fax:860-893-0301
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001404722Medicaid
CT1750375127OtherNPI INDIVIDUAL
CT1750375127OtherNPI INDIVIDUAL
CT001404722Medicaid