1588630883 NPI number — NANCY ZLOMEK FNP

Table of content: NANCY ZLOMEK FNP (NPI 1588630883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588630883 NPI number — NANCY ZLOMEK FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZLOMEK
Provider First Name:
NANCY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1588630883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 PEWTER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANLIUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13104-9707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-682-5710
Provider Business Mailing Address Fax Number:
315-682-9401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4212 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
EASTSIDE INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13066-6642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-329-7017
Provider Business Practice Location Address Fax Number:
315-329-7025
Provider Enumeration Date:
02/27/2006

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: 363LA2200X , with the licence number:  F3305791 , 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: 01533715 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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