Healthcare Provider Details

I. General information

NPI: 1831376268
Provider Name (Legal Business Name): TERESA E ZIERDEN LANDMESSER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N CHURCH ST
HAZLETON PA
18201-1800
US

IV. Provider business mailing address

415 N MAIN ST
WILKES BARRE PA
18702-4411
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-4467
  • Fax: 570-454-0413
Mailing address:
  • Phone: 570-208-5571
  • Fax: 570-208-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003584L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TERESA E ZIERDEN LANDMESSER
Title or Position: OWNER
Credential: DPM
Phone: 570-454-4467