Healthcare Provider Details

I. General information

NPI: 1346591609
Provider Name (Legal Business Name): ZION ZIBLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VALLEY DR STE 201
GREENWICH CT
06831-5205
US

IV. Provider business mailing address

15 VALLEY DR STE 201
GREENWICH CT
06831-5205
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-2096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number57.020807
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number72990
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: