1225056294 NPI number — HEIDI ZINKAND M.D.

Table of content: HEIDI ZINKAND M.D. (NPI 1225056294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225056294 NPI number — HEIDI ZINKAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINKAND
Provider First Name:
HEIDI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1225056294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214C LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14608-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-423-5800
Provider Business Mailing Address Fax Number:
585-423-2890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14608-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-254-6480
Provider Business Practice Location Address Fax Number:
585-254-1090
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  171836 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P010171836 . This is a "BLUE CHOICE ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 101209BF . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 171836 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080053769 . This is a "RAILROAD MCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6938 . This is a "BLUE CROSS ROCHESTER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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