1447458872 NPI number — GEORGE P. ZUK, JR., D.P.M.

Table of content: (NPI 1447458872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447458872 NPI number — GEORGE P. ZUK, JR., D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE P. ZUK, JR., D.P.M.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRISTOL SHOE COMPANY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447458872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 NORTH ST
Provider Second Line Business Mailing Address:
P.O. BOX 1872
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06010-4148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-585-0585
Provider Business Mailing Address Fax Number:
860-585-0602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 NORTH ST
Provider Second Line Business Practice Location Address:
FLOOR 1
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06010-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-585-0585
Provider Business Practice Location Address Fax Number:
860-585-0602
Provider Enumeration Date:
07/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZUK
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-585-0585

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)