Healthcare Provider Details

I. General information

NPI: 1811273337
Provider Name (Legal Business Name): KEVIN SCOTT ZAKIELARZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S 22ND ST APT 1
PHILADELPHIA PA
19146-1255
US

IV. Provider business mailing address

723 S 22ND ST APT 1
PHILADELPHIA PA
19146-1255
US

V. Phone/Fax

Practice location:
  • Phone: 617-275-6836
  • Fax:
Mailing address:
  • Phone: 617-275-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number308769
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058194
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA058194
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: