1396207593 NPI number — ANGELO ZIENO

Table of content: (NPI 1396207593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396207593 NPI number — ANGELO ZIENO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELO ZIENO
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:
1396207593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2225 JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68005-5241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-315-9893
Provider Business Mailing Address Fax Number:
855-825-2627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68005-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-315-9893
Provider Business Practice Location Address Fax Number:
855-825-2627
Provider Enumeration Date:
04/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ZIENO
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
SALVATORE
Authorized Official Title or Position:
OWNER/PSYCHIATRIST
Authorized Official Telephone Number:
402-315-9893

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10026765500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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