Active NPI
Fatbardha Kodzodziku, PA
- Medical Physician Assistant
- Greenwich, CT
National Provider Identifier
1659769354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3227
- Practice address
- 1 E Putnam Ave
Greenwich, CT 06830-5429 - Phone
- (203) 340-9611
- NPI assigned
- Jan 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3227 | CT | Primary |
Addresses
Primary practice location
1 E Putnam Ave
Greenwich, CT 06830-5429
Mailing address
1 E Putnam Ave
Greenwich, CT 06830-5429
Phone (203) 340-9611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3227 | CT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481673600000",
"number": "1659769354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 E PUTNAM AVE",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068305429",
"telephone_number": "203-340-9611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E PUTNAM AVE",
"city": "GREENWICH",
"state": "CT",
"postal_code": "068305429",
"telephone_number": "203-340-9611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODZODZIKU",
"first_name": "FATBARDHA",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-03",
"last_updated": "2016-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CT",
"license": "3227",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.