Provider Demographics
NPI:1558088161
Name:ZEMANEK, GLENN JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:JOHN
Last Name:ZEMANEK
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 1:6 HOMEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1606
Mailing Address - Country:US
Mailing Address - Phone:914-646-4147
Mailing Address - Fax:
Practice Address - Street 1:6 HOMEWOOD RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1606
Practice Address - Country:US
Practice Address - Phone:914-646-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002804213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty