Healthcare Provider Details

I. General information

NPI: 1689381832
Provider Name (Legal Business Name): CHARLES ZAJAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 WESTERN AVE STE 102
ALBANY NY
12203-3539
US

IV. Provider business mailing address

16 SHERIDAN AVE APT 523
ALBANY NY
12210-2757
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-0050
  • Fax:
Mailing address:
  • Phone: 518-423-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number705152
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number705152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: