Provider Demographics
NPI:1063011286
Name:ZELENCICH, DONNA M
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:ZELENCICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SACANDAGA LOOP
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-7097
Mailing Address - Country:US
Mailing Address - Phone:845-406-8637
Mailing Address - Fax:
Practice Address - Street 1:18 STRACK DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1596
Practice Address - Country:US
Practice Address - Phone:845-831-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672137-1163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology