Provider Demographics
NPI:1699881557
Name:THE CONNECTICUT DERMATOLOGY GROUP PLLC
Entity type:Organization
Organization Name:THE CONNECTICUT DERMATOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KOLENIK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:203-810-4151
Mailing Address - Street 1:761 MAIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-810-4151
Mailing Address - Fax:203-810-4150
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-810-4151
Practice Address - Fax:203-810-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty