Provider Demographics
NPI:1376537563
Name:ZACHARY, KIRK J (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:J
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7208
Mailing Address - Country:US
Mailing Address - Phone:212-772-6709
Mailing Address - Fax:212-288-8228
Practice Address - Street 1:40 CROSS ST
Practice Address - Street 2:4TH FL
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4647
Practice Address - Country:US
Practice Address - Phone:203-845-4835
Practice Address - Fax:203-845-4870
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027807207RG0100X
NY135415207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA62802Medicare UPIN