Provider Demographics
NPI:1902693252
Name:GORE, ZIASIA
Entity type:Individual
Prefix:
First Name:ZIASIA
Middle Name:
Last Name:GORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 W TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:254 W TRENTON AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-2003
Practice Address - Country:US
Practice Address - Phone:215-970-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician