Healthcare Provider Details

I. General information

NPI: 1902965007
Provider Name (Legal Business Name): Z INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MIDDLE HADDAM RD
COBALT CT
06414-0246
US

IV. Provider business mailing address

PO BOX 246 29 MIDDLE HADDAM RD
COBALT CT
06414-0246
US

V. Phone/Fax

Practice location:
  • Phone: 860-267-9034
  • Fax: 860-267-8617
Mailing address:
  • Phone: 860-267-9034
  • Fax: 860-267-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier715
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLUE CROSS
# 2
Identifier0008136
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: MR. TODD P ZGORSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-267-9034