Provider Demographics
NPI:1649206053
Name:ZONDERMAN, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:ZONDERMAN
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 1:820 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3004
Mailing Address - Country:US
Mailing Address - Phone:518-828-3391
Mailing Address - Fax:518-828-6734
Practice Address - Street 1:2222 6TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2203
Practice Address - Country:US
Practice Address - Phone:518-274-3123
Practice Address - Fax:518-274-0624
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190283Medicaid
NYH07574Medicare UPIN
J400008006Medicare PIN
NY02190283Medicaid