Provider Demographics
NPI:1386646289
Name:ZIEMBA, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:ZIEMBA
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 1:1458 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2634
Mailing Address - Country:US
Mailing Address - Phone:718-438-0600
Mailing Address - Fax:718-437-7324
Practice Address - Street 1:1458 47TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2634
Practice Address - Country:US
Practice Address - Phone:718-438-0600
Practice Address - Fax:718-437-7324
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
92A241Medicare ID - Type Unspecified
C12338Medicare UPIN