Healthcare Provider Details

I. General information

NPI: 1457392250
Provider Name (Legal Business Name): DAVID H ZORNOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD
ALBANY NY
12208-1742
US

IV. Provider business mailing address

319 S MANNING BLVD
ALBANY NY
12208-1743
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-1019
  • Fax: 518-438-0981
Mailing address:
  • Phone: 518-438-1019
  • Fax: 518-438-0981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number099024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: