Basic Information
| Provider Information | |||||||||
| NPI: | 1962656314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALEK | ||||||||
| FirstName: | JEFREY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 WAWECUS ST. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
| FaxNumber: | 8608879003 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 WAWECUS ST. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
| FaxNumber: | 8608879003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 02/28/2013 | ||||||||
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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 | 207RG0100X | 050701 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 010050701CT01 | 01 | CT | ANTHEM BLUE CROSS BLUE SHIELD OF CT | OTHER | P4569410 | 01 | CT | OXFORD UNITED HEALTHCARE | OTHER | 507010 | 01 | CT | CONNECTICARE | OTHER | 5064741 | 01 | CT | CIGNA | OTHER |