Provider Demographics
NPI:1326147182
Name:ZAMECKI, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:ZAMECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128A GLEN ST
Mailing Address - Street 2:INTERNAL MEDICINE & GERIATRICS, P.C.
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2737
Mailing Address - Country:US
Mailing Address - Phone:516-802-5562
Mailing Address - Fax:516-802-5563
Practice Address - Street 1:128A GLEN ST
Practice Address - Street 2:INTERNAL MEDICINE & GERIATRICS, P.C.
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2737
Practice Address - Country:US
Practice Address - Phone:516-802-5562
Practice Address - Fax:516-802-5563
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193669174400000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG22018Medicare UPIN
NY110101Medicare ID - Type Unspecified