Healthcare Provider Details

I. General information

NPI: 1194107326
Provider Name (Legal Business Name): RUSSELL ZAPKO COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EDELLA ROAD
SOUTH ABINGTON PA
18411
US

IV. Provider business mailing address

100 EDELLA ROAD
SOUTH ABINGTON PA
18411
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-1002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP006001
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: