| Edward Shukovsky | |
|
1290 Summer St Suite 3400 Stamford CT 06905-5360 | |
| (203) 348-2411 | |
| (203) 348-5895 |
| Full Name | Edward Shukovsky |
|---|---|
| Speciality | Dentist |
| Location | 1290 Summer St, Stamford, Connecticut |
| Authorized Official Name and Position | Edward Shukovsky (OWNER) |
| Authorized Official Contact | 2033482411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward Shukovsky 1290 Summer St Suite 3400 Stamford CT 06905-5360 Ph: (203) 348-2411 | Edward Shukovsky 1290 Summer St Suite 3400 Stamford CT 06905-5360 Ph: (203) 348-2411 |
| NPI Number | 1619362571 |
|---|---|
| Provider Enumeration Date | 03/30/2015 |
| Last Update Date | 03/30/2015 |
| Medicare PECOS PAC ID | 5991018509 |
|---|---|
| Medicare Enrollment ID | O20150724010679 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619362571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 005762 (Connecticut) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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