Healthcare Provider Details

I. General information

NPI: 1528049327
Provider Name (Legal Business Name): RALPH JOSEPH ZWOLINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 S RIDGEWOOD AVE SUITE 102
PORT ORANGE FL
32127-5169
US

IV. Provider business mailing address

1673 MASON AVE SUITE 107
DAYTONA BEACH FL
32117-5515
US

V. Phone/Fax

Practice location:
  • Phone: 386-763-4484
  • Fax: 386-763-1288
Mailing address:
  • Phone: 386-274-7118
  • Fax: 386-274-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number000046005
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME 46005
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME 46005
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberNE 46005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: