Healthcare Provider Details

I. General information

NPI: 1528339439
Provider Name (Legal Business Name): EDWARD JAN ZALOGA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 N WASHINGTON AVE
SCRANTON PA
18509-2840
US

IV. Provider business mailing address

4101 BIRNEY AVE
MOOSIC PA
18507-1323
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-7364
  • Fax: 570-343-7367
Mailing address:
  • Phone: 570-343-7364
  • Fax: 570-343-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS006696E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS006696E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: