Basic Information
| Provider Information | |||||||||
| NPI: | 1598150609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNGER | ||||||||
| FirstName: | WOJCIECH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 SILAS DEANE HWY | ||||||||
| Address2: | |||||||||
| City: | ROCKY HILL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060672313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602583470 | ||||||||
| FaxNumber: | 8605716811 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 CRANBROOK BLVD | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602535330 | ||||||||
| FaxNumber: | 8602535331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2015 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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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 | 363LA2200X | 006072 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 006072 | 01 | CT | LICENSE | OTHER |