Provider Demographics
NPI:1588630883
Name:ZLOMEK, NANCY (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ZLOMEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PEWTER LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9707
Mailing Address - Country:US
Mailing Address - Phone:315-682-5710
Mailing Address - Fax:315-682-9401
Practice Address - Street 1:4212 MEDICAL CENTER DR
Practice Address - Street 2:EASTSIDE INTERNAL MEDICINE
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6642
Practice Address - Country:US
Practice Address - Phone:315-329-7017
Practice Address - Fax:315-329-7025
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3305791363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01533715Medicaid
NYS86882Medicare UPIN
NYBB6118Medicare ID - Type Unspecified
NY01533715Medicaid
NYP00385337Medicare PIN