Healthcare Provider Details

I. General information

NPI: 1528025863
Provider Name (Legal Business Name): JOSEPH DOMINIC ZOLLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ELM ST
POTSDAM NY
13676-2166
US

IV. Provider business mailing address

50 LEROY ST
POTSDAM NY
13676-1786
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-3300
  • Fax:
Mailing address:
  • Phone: 315-265-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number253749
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2114391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: