Provider Demographics
NPI:1215910922
Name:JURZYK, RONALD S (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:JURZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2626
Mailing Address - Country:US
Mailing Address - Phone:203-879-6171
Mailing Address - Fax:203-879-1191
Practice Address - Street 1:464 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2626
Practice Address - Country:US
Practice Address - Phone:203-879-6171
Practice Address - Fax:203-879-1191
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035267207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01035267OtherCIGNA
CT113666656OtherUNITED HEALTHCARE
CT010035267CT01OtherANTHEM BLUE CROSS
CT035267OtherCONNECTICARE
CT0706312OtherAETNA
CTP00083127OtherRAILROAD MEDICARE
CO270791OtherWELLCARE
CT2V2970OtherHEALTHNET
CT270791OtherWELLCARE
CTP437247OtherOXFORD
CTP00083127OtherRAILROAD MEDICARE
CT01035267OtherCIGNA