1497239651 NPI number — TIFFANY D ZAJACS CRNP

Table of content: TIFFANY D ZAJACS CRNP (NPI 1497239651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497239651 NPI number — TIFFANY D ZAJACS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAJACS
Provider First Name:
TIFFANY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1497239651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8150 PERRY HWY STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-369-9550
Provider Business Mailing Address Fax Number:
412-369-9566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8150 PERRY HWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-364-2664
Provider Business Practice Location Address Fax Number:
412-364-8037
Provider Enumeration Date:
09/23/2018

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: 363LF0000X , with the licence number:  SP018101 , 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: 103602891-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".