Provider Demographics
NPI:1588073530
Name:IRVING, ZACHARY JAMES (LPN)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JAMES
Last Name:IRVING
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 COBBLESTONE DR
Mailing Address - Street 2:APT S2
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9001
Mailing Address - Country:US
Mailing Address - Phone:315-720-5363
Mailing Address - Fax:
Practice Address - Street 1:6112 COBBLESTONE DR
Practice Address - Street 2:APT S2
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9001
Practice Address - Country:US
Practice Address - Phone:315-720-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse