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General NPI Number Information
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NPI Number | 1063650257
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Entity Type | Organization
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Legal Business Name | DR. O. GREGORY ZAZULAK, MD, PC
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 6 E MAIN ST
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1213
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Country | US
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Telephone | 315-462-7694
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Fax | 315-462-5248
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Provider Business Mailing Address
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Address Line | 6 E MAIN ST
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-1213
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Country | US
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Telephone | 315-462-7694
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Fax | 315-462-5248
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. O. GREGORY ZAZULAK
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Credential | M.D., P.C.
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Telephone | 315-462-7694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 178871
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License Number State | NY
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