Healthcare Provider Details

I. General information

NPI: 1578169603
Provider Name (Legal Business Name): GARY ZORNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SOUTH SYCAMORE ST
NORTH LEWISBURG OH
43060
US

IV. Provider business mailing address

PO BOX 75
NORTH LEWISBURG OH
43060-0075
US

V. Phone/Fax

Practice location:
  • Phone: 614-531-3118
  • Fax:
Mailing address:
  • Phone: 614-531-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: