Basic Information
| Provider Information | |||||||||
| NPI: | 1598864217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIEKARZ-DYJAK | ||||||||
| FirstName: | ELZBIETA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 MAIN ST FL 2 | ||||||||
| Address2: | COMMUNITY HEALTH CENTER, INC. | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064572845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603476971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 LAFAYETTE STREET | ||||||||
| Address2: | COMMUNITY HEALTH CENTER, INC. | ||||||||
| City: | NEW BRITAIN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602243642 | ||||||||
| FaxNumber: | 8602242760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 017640 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 046455 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 008004591 | 05 | CT | MEDICAID | 004236346 | 05 | CT | MEDICAID |