Individual
JAN IDZIKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
273 COUNTY RD, NEW LONDON, NH 03257-5736
(603) 526-2911
Mailing address
273 COUNTY RD, NEW LONDON, NH 03257-5736
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1188
NH
363AS0400X
Surgical Physician Assistant
585
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42889057
—
CO
Enumeration date
06/24/2005
Last updated
01/08/2020
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