Provider Demographics
NPI:1750317699
Name:ZUMPANO, MAUREEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:ZUMPANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CORTLAND LN
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-3003
Mailing Address - Country:US
Mailing Address - Phone:313-768-4384
Mailing Address - Fax:
Practice Address - Street 1:125 BROOKLEY RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4301
Practice Address - Country:US
Practice Address - Phone:315-334-7100
Practice Address - Fax:315-334-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301126363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN