1619930708 NPI number — DR. DEBORAH TANYA ZAREK M.D.

Table of content: DR. DEBORAH TANYA ZAREK M.D. (NPI 1619930708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619930708 NPI number — DR. DEBORAH TANYA ZAREK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAREK
Provider First Name:
DEBORAH
Provider Middle Name:
TANYA
Provider Name Prefix Text:
DR.
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:
ZAREK
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
TANYA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619930708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3521 SILVERSIDE RD STE 2J
Provider Second Line Business Mailing Address:
CONCORD PLAZA, RIDGELY BLDG.
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-543-5454
Provider Business Mailing Address Fax Number:
302-327-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3521 SILVERSIDE RD STE 2J
Provider Second Line Business Practice Location Address:
CONCORD PLAZA, RIDGELY BLDG.
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-543-5454
Provider Business Practice Location Address Fax Number:
302-327-4200
Provider Enumeration Date:
04/10/2006

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: 207R00000X , with the licence number:  C10006537 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000024689 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 170694 . This is a "MEDICARE ID- TYPE UNSPECIFIED" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 134247868 . This is a "TAX ID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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