Provider Demographics
NPI:1073066577
Name:CAMECHIS, ZACHARY JAY (IDC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAY
Last Name:CAMECHIS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HORNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3009
Mailing Address - Country:US
Mailing Address - Phone:224-619-9213
Mailing Address - Fax:
Practice Address - Street 1:177 HORNBEAM RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3009
Practice Address - Country:US
Practice Address - Phone:224-619-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman