Provider Demographics
NPI:1326057514
Name:ZAWADA, STANLEY JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOHN
Last Name:ZAWADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 150TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1752
Mailing Address - Country:US
Mailing Address - Phone:718-767-5555
Mailing Address - Fax:718-767-5353
Practice Address - Street 1:1257 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1752
Practice Address - Country:US
Practice Address - Phone:718-767-5555
Practice Address - Fax:718-767-5353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN-003845213ER0200X, 213ES0000X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00858168Medicaid