Provider Demographics
NPI:1912190018
Name:ZAWACKI, EDWARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:ZAWACKI
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 1:62 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2217
Mailing Address - Country:US
Mailing Address - Phone:516-578-1557
Mailing Address - Fax:516-358-6174
Practice Address - Street 1:62 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2217
Practice Address - Country:US
Practice Address - Phone:516-578-1557
Practice Address - Fax:516-358-6174
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00-3396-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX18531Medicare PIN