Provider Demographics
NPI:1124890306
Name:ZIOBRO, MARK EDWARD (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:ZIOBRO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAYTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12849-5200
Mailing Address - Country:US
Mailing Address - Phone:631-275-6686
Mailing Address - Fax:
Practice Address - Street 1:25 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5882
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720998-01163W00000X
NY720990-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse