Healthcare Provider Details

I. General information

NPI: 1396806295
Provider Name (Legal Business Name): JOHN J. ZYGMUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 434 VESTAL PARKWAY
BINGHAMTON NY
13902-6000
US

IV. Provider business mailing address

3 PAMELA DR.
JOHNSON CITY NY
13790
US

V. Phone/Fax

Practice location:
  • Phone: 607-777-2221
  • Fax:
Mailing address:
  • Phone: 607-798-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number112861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: