Provider Demographics
NPI:1366611709
Name:O GREGORY ZAZULAK, MD, PC
Entity type:Organization
Organization Name:O GREGORY ZAZULAK, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLEH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:ZAZULAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-473-6700
Mailing Address - Street 1:890 WESTFALL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 WESTFALL RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2610
Practice Address - Country:US
Practice Address - Phone:585-473-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178871261QM2500X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1142900002Medicare NSC
NY12167BMedicare PIN
NJ12166BMedicare PIN
NY1142900001Medicare NSC