Provider Demographics
NPI:1154349058
Name:STOCKI, JERZY (DR)
Entity type:Individual
Prefix:DR
First Name:JERZY
Middle Name:
Last Name:STOCKI
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 NORWICH- WESTERLY RD.
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359
Mailing Address - Country:US
Mailing Address - Phone:860-599-2469
Mailing Address - Fax:860-599-2830
Practice Address - Street 1:82 NORWICH WESTERLY RD
Practice Address - Street 2:
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1744
Practice Address - Country:US
Practice Address - Phone:860-599-2469
Practice Address - Fax:860-599-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110003877Medicare ID - Type Unspecified
CTB37795Medicare UPIN