Provider Demographics
NPI:1801095724
Name:ZMIJEWSKI, MARIA G (RPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:ZMIJEWSKI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4498
Mailing Address - Country:US
Mailing Address - Phone:860-666-5689
Mailing Address - Fax:860-667-0211
Practice Address - Street 1:256 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4498
Practice Address - Country:US
Practice Address - Phone:860-666-5689
Practice Address - Fax:860-667-0211
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist