Provider Demographics
NPI:1386921104
Name:THEODOR V.B. VON ZIELINSKI, M.D., P.A.
Entity type:Organization
Organization Name:THEODOR V.B. VON ZIELINSKI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODOR
Authorized Official - Middle Name:VB
Authorized Official - Last Name:VON ZIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-8773
Mailing Address - Street 1:777 37TH ST
Mailing Address - Street 2:C104
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4873
Mailing Address - Country:US
Mailing Address - Phone:772-562-8773
Mailing Address - Fax:772-562-0646
Practice Address - Street 1:777 37TH ST
Practice Address - Street 2:C104
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4873
Practice Address - Country:US
Practice Address - Phone:772-562-8773
Practice Address - Fax:772-562-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0850AOtherPROVIDER I.D.
FLF0850AMedicare UPIN