Basic Information
| Provider Information | |||||||||
| NPI: | 1275542623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLENSKI | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 FRANKLIN ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 133 SCOVILL ST STE 308 | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096680 | ||||||||
| FaxNumber: | 2037096683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 70496 | WI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME109934 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 25MA09184300 | NJ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 64557 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.