Healthcare Provider Details

I. General information

NPI: 1194690909
Provider Name (Legal Business Name): LAURIE A ZIRILLI MA RD CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 AIRLINE ST STE 201
ORISKANY NY
13424-4221
US

IV. Provider business mailing address

211 MARINEVIEW DR
CHITTENANGO NY
13037-4050
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-5456
  • Fax:
Mailing address:
  • Phone: 607-287-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002416-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: