Healthcare Provider Details

I. General information

NPI: 1821581802
Provider Name (Legal Business Name): GREGORY WILLIAM ZILLI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

819 WARRINGTON PL
DAYTON OH
45419-3647
US

V. Phone/Fax

Practice location:
  • Phone: 615-665-1000
  • Fax:
Mailing address:
  • Phone: 215-292-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2292900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: