1396747556 NPI number — MARCIN MAREK ZYGAWSKI M.D.

Table of content: MARCIN MAREK ZYGAWSKI M.D. (NPI 1396747556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396747556 NPI number — MARCIN MAREK ZYGAWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZYGAWSKI
Provider First Name:
MARCIN
Provider Middle Name:
MAREK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1396747556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 WILLIAMS ST
Provider Second Line Business Mailing Address:
SUITE #3
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-7463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-445-4564
Provider Business Mailing Address Fax Number:
413-448-2727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 WILLIAMS ST
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-7463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-445-4564
Provider Business Practice Location Address Fax Number:
413-448-2727
Provider Enumeration Date:
06/01/2005

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: 174400000X , with the licence number:  231111-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 231111-1 , 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: 101090936 0001 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110103937A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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