1710245840 NPI number — LENKA ZACHAR MD PLC

Table of content: (NPI 1710245840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710245840 NPI number — LENKA ZACHAR MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LENKA ZACHAR MD PLC
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:
1710245840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 MARGARET ST
Provider Second Line Business Mailing Address:
SUITE 302 BOX 148
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32204-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-308-5266
Provider Business Mailing Address Fax Number:
904-308-5267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 SHIRCLIFF WAY STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-308-5266
Provider Business Practice Location Address Fax Number:
904-308-5267
Provider Enumeration Date:
04/26/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZACHAR
Authorized Official First Name:
LENKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-308-5266

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME68497 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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