Provider Demographics
NPI:1710991658
Name:ZYGELMAN, LEO (DC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:ZYGELMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3534
Mailing Address - Country:US
Mailing Address - Phone:203-795-5244
Mailing Address - Fax:203-795-9510
Practice Address - Street 1:370 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3534
Practice Address - Country:US
Practice Address - Phone:203-795-5244
Practice Address - Fax:203-795-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT207OtherLANDMARK
CT050000207CT01OtherBLUE CROSS