1174531214 NPI number — ALBERT J ZANETTI, D.O., P.C.

Table of content: (NPI 1174531214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174531214 NPI number — ALBERT J ZANETTI, D.O., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERT J ZANETTI, D.O., P.C.
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:
Provider Other Organization Name Type Code:
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:
1174531214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 N 67TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-564-2439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 N 67TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-564-2439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZANETTI
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-564-2439

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  OS005685L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03070400 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010234940001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001362330 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".