Healthcare Provider Details

I. General information

NPI: 1356323067
Provider Name (Legal Business Name): PHILIP W ZINGALE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE SUITE 245
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

1539 ATWOOD AVE SUITE 201
JOHNSTON RI
02919-3262
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-6080
  • Fax: 401-521-6092
Mailing address:
  • Phone: 401-521-6080
  • Fax: 401-521-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberCPA00014
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: