Healthcare Provider Details

I. General information

NPI: 1972538908
Provider Name (Legal Business Name): THEODORE LEE ZIFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BROTHER GEENEN WAY
SARASOTA FL
34236-7102
US

IV. Provider business mailing address

1800 E PARK AVE
STATE COLLEGE PA
16803-6709
US

V. Phone/Fax

Practice location:
  • Phone: 941-556-3220
  • Fax: 941-955-8214
Mailing address:
  • Phone: 814-234-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD032308E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: