Provider Demographics
NPI:1386797983
Name:ZIGROSSER, KENNETH EDWARD (PA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWARD
Last Name:ZIGROSSER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5013
Mailing Address - Country:US
Mailing Address - Phone:518-445-4444
Mailing Address - Fax:518-618-1665
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5013
Practice Address - Country:US
Practice Address - Phone:518-445-4444
Practice Address - Fax:518-618-1665
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2024-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002284363A00000X
FLPA9117585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00553OtherLICENSE
NY002284OtherMEDICAL LICENSE