Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 043106 | CT |
NPI | 1407830367 |
---|---|
Provider Name | Hetal Sushil Kocinsky |
First Address | New Haven, CT 06536-0805 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00143106Y | (05) | CT |
I36133 | (02) |