Provider Demographics
NPI:1790413326
Name:ZWINGELBERG, PHILIP (FNP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:ZWINGELBERG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 COUNTY ROUTE 61
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-3806
Mailing Address - Country:US
Mailing Address - Phone:518-470-8616
Mailing Address - Fax:
Practice Address - Street 1:50 NEW SCOTLAND AVE FL 3
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3403
Practice Address - Country:US
Practice Address - Phone:518-262-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily