Provider Demographics
NPI:1710462460
Name:VAN ZILE, PHILIP TAYLOR IV (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:TAYLOR
Last Name:VAN ZILE
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ALLEQUIPPA ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219
Mailing Address - Country:US
Mailing Address - Phone:412-360-6100
Mailing Address - Fax:
Practice Address - Street 1:4100 ALLEQUIPPA ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:412-360-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical