MR. JOHN D WYSOCKI (NPI# 1457594103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457594103 |
| Entity Type | Individual |
| Full Name | MR. JOHN D WYSOCKI |
| Credential | MD |
| Practice Address |
2400 Tamarack Ave Suite 101 South Windsor CT 06074-5555 |
| Mailing Address |
2139 Silas Deane Hwy Rocky Hill CT 06067-2336 |
| Practice Telephone | 8606444442 |
| Practice Fax Number | 8606441412 |
| Mailing Telephone | (860) 257-4131 |
| Mailing Fax Number | 8602574519 |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
055947 | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | CIGNA | 7019762 | 01 |
| CT | AETNA | 4886159 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 85 Seymour St Ste 1000, Hartford, CT 061065555 | 8602462571 | 8602463691 |
| 300 Western Blvd Ste A, Glastonbury, CT 060334305 | 8606571920 |
| Street Address |
2400 TAMARACK AVE SUITE 101 |
| City | SOUTH WINDSOR |
| State | CT |
| Zip Code | 06074-5555 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306821863 | Jeffrey Robert Breiter | Internal Medicine | 2400 Tamarack Ave, Suite 101, South Windsor, CT 06074-5539 | 2005-12-07 |
| 1235606443 | Lina M Garcia | Nurse Practitioner | 2400 Tamarack Ave, South Windsor, CT 06074-5555 | 2018-10-25 |
| 1730442179 | Wbc Connecticut East, LLC | Clinic/Center | 2400 Tamarack Ave, Suite 203, South Windsor, CT 06074-5555 | 2012-06-20 |
| 1760762538 | Melissa Ann Hodgson | Psychologist | 2400 Tamarack Ave, Suite 201, South Windsor, CT 06074-5559 | 2011-08-24 |
| 1467614669 | Sarah Blumengarten Crawford | Psychologist | 2400 Tamarack Ave, Ste 201, South Windsor, CT 06074-5559 | 2008-06-28 |
| 1164600615 | Marcy Lynn Qureshi | Internal Medicine | 2400 Tamarack Ave, Suite 101, South Windsor, CT 06074-5555 | 2008-02-07 |
| 1295710770 | Beth A Lemek | Physician Assistant | 2400 Tamarack Ave, Suite 101, South Windsor, CT 06074-5539 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174144919 | Russo Therapeutics, LLC | Occupational Therapist | 561 King Street, South Windsor, CT 06074 | 2020-05-04 |
| 1144706631 | Chana Judith Hoagland | Nurse Practitioner | 276 Quarry Brook Drive, South Windsor, CT 06074 | 2018-07-17 |
| 1093203291 | Climb Medical Group LLC | Counselor | 828 Sullivan Ave Ste A, South Windsor, CT 06074 | 2018-04-24 |
| 1528506516 | William P Guinan, Md and Associates LLC | Obstetrics & Gynecology | 25 Oakland Road, South Windsor, CT 06074 | 2017-02-09 |
| 1487027678 | Nadine Caron | Nurse Practitioner | 34 Pleasant Valley Rd, South Windsor, CT 06074 | 2015-11-10 |
| 1275957920 | Ellen Carol Ronsivalli | Dietitian, Registered | 70 High Street, South Windsor, CT 06074 | 2014-02-14 |
| 1881036457 | Chandra Yellinedi | Pharmacist | 55 Frazer Fir, South Windsor, CT 06074 | 2013-07-24 |
| 1144665969 | Brian Thomas Moy | Internal Medicine | 2400 Tamarack Ave Ste 101, South Windsor, CT 06074 | 2013-05-07 |
| 1093072886 | Lydia Lormand | Obstetrics & Gynecology | 2600 Tamarack Ave Ste 200, South Windsor, CT 06074 | 2012-04-18 |
| 1578847307 | International Institute for Professional Development, LLC | Social Worker | 435 Buckland Hills Road, South Windsor, CT 06074 | 2011-09-28 |
| Find all providers in zip 06074 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144665969 | Brian Thomas Moy | Internal Medicine | 2400 Tamarack Ave Ste 101, South Windsor, CT 06074 | 2013-05-07 |
| 1306821863 | Jeffrey Robert Breiter | Internal Medicine | 2400 Tamarack Ave, Suite 101, South Windsor, CT 06074-5539 | 2005-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730525734 | Benjamin Barbash | Internal Medicine | 888 White Plains Rd Ste 110, Trumbull, CT 06611-4552 | 2013-05-16 |
| 1598109753 | Radhika Naga Ayyagari | Internal Medicine | Prime Healthcare PC, 44 Dale Rd, Avon, CT 06001-4320 | 2013-04-18 |
| 1205279247 | Jared Macklin | Internal Medicine | 800 Boston Post Rd Ste 201, Guilford, CT 06437 | 2013-04-09 |
| 1316209141 | Jenna Koliani-pace | Internal Medicine | 300 Western Blvd Ste A, Glastonbury, CT 06033-4305 | 2012-06-07 |
| 1891055323 | Martin H. Floch,m.d.pc | Internal Medicine | 32 Woody Ln, Westport, CT 06880-2259 | 2012-05-17 |
| 1720396567 | Breiter Tech Corp | Internal Medicine | 2842 Main St, Ste 309, Glastonbury, CT 06033-1077 | 2010-09-14 |
| 1275775058 | Donald E. Gullickson IIi | Internal Medicine | Uconn Health Center 263 Farmington Ave, Farmington, CT 06030-0001 | 2009-03-25 |
| 1356582571 | Miechelle L. O'brien | Internal Medicine | 111 Osborne Street- Ste 121, Danbury, CT 06810-6019 | 2009-03-18 |
| 1962656314 | Jefrey Salek | Internal Medicine | 79 Wawecus St., Suite 101, Norwich, CT 06360-2173 | 2008-11-12 |
| 1790945996 | Amzad Khan | Internal Medicine | 234a Bank St., 4th Floor, New London, CT 06320-6054 | 2008-06-11 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH WINDSOR |
| Zip Code | 06074 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.