Healthcare Provider Details

I. General information

NPI: 1043982457
Provider Name (Legal Business Name): TIRESHA SIMONE ZEIGLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-0762
  • Fax:
Mailing address:
  • Phone: 718-442-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number291694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: