Provider Demographics
NPI:1851450068
Name:ZWIBELMAN, JAY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:SCOTT
Last Name:ZWIBELMAN
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 1:3008 W 89TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1720
Mailing Address - Country:US
Mailing Address - Phone:913-642-3565
Mailing Address - Fax:
Practice Address - Street 1:601 N MUR LEN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5415
Practice Address - Country:US
Practice Address - Phone:913-642-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-236552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS033D00075Medicare PIN
KSE88843Medicare UPIN