Healthcare Provider Details

I. General information

NPI: 1336170083
Provider Name (Legal Business Name): WAYNE CRUZ ZWICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DELAWARE VETERANS BLVD
MILFORD DE
19963-5395
US

IV. Provider business mailing address

16 KINGSTON TER
MILFORD DE
19963-4168
US

V. Phone/Fax

Practice location:
  • Phone: 302-424-6000
  • Fax:
Mailing address:
  • Phone: 260-485-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number01051725A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberC10002773
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10002773
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051725A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: