Individual provider Active NPI

Joanna Zolkowski-Wynne, M.D.

  • Pediatrics Physician
  • Bridgeport, CT
National Provider Identifier
1033178306
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
027409 Issued in CT
Practice address
226 Mill Hill Ave
3Rd Floor
Bridgeport, CT 06610-2811
Phone
(203) 384-3873
Fax
(203) 384-3829
NPI assigned
Mar 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 027409 CT
Pediatrics Physician 208000000X 027409 CT Primary

Addresses

Primary practice location

226 Mill Hill Ave
3Rd Floor
Bridgeport, CT 06610-2811

Mailing address

PO Box 5246
Bridgeport, CT 06610-0246
Phone (203) 384-3873

Other identifiers 1

IdentifierTypeStateIssuer
001274092MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100325000557 CT Practitioner - Pediatric Medicine 2365578648 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
027409CTMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Pediatrics CurrentSince Feb 8, 2010 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Feb 8, 2010 Accepting new patients

Locations

226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664236800000",
    "number": "1033178306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5246",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066100246",
            "telephone_number": "203-384-3873",
            "fax_number": "203-384-3829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 MILL HILL AVE",
            "address_2": "3RD FLOOR",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102811",
            "telephone_number": "203-384-3873",
            "fax_number": "203-384-3829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOLKOWSKI-WYNNE",
        "first_name": "JOANNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "027409",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "027409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001274092",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.