Healthcare Provider Details

I. General information

NPI: 1356434187
Provider Name (Legal Business Name): GEORGE S. ZUBENKO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 PERRY HIGHWAY SUITE 204
WEXFORD PA
15090-7612
US

IV. Provider business mailing address

12300 PERRY HIGHWAY SUITE 204
WEXFORD PA
15090-7612
US

V. Phone/Fax

Practice location:
  • Phone: 724-719-2303
  • Fax: 724-719-2303
Mailing address:
  • Phone: 724-719-2303
  • Fax: 724-719-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD030320E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD030320E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: