Healthcare Provider Details

I. General information

NPI: 1841329109
Provider Name (Legal Business Name): RONALD ZIEZIULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MARTIN AVE
EPHRATA PA
17522-1724
US

IV. Provider business mailing address

1000 HADDONFIELD BERLIN RD SUITE 210
VOORHEES NJ
08043-3520
US

V. Phone/Fax

Practice location:
  • Phone: 717-733-0311
  • Fax: 717-721-5929
Mailing address:
  • Phone: 856-782-2212
  • Fax: 856-782-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD012491E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: