=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881479913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY PHENES MS, FNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2023
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 CENTER WAY
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14830-2287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-973-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 CENTER WAY
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14830-2287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-973-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 033545
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 35740701
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------