Provider Demographics
NPI:1972355279
Name:ZDRODOWSKI, JOSEPH BENJAMIN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:ZDRODOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1421
Mailing Address - Country:US
Mailing Address - Phone:314-289-7659
Mailing Address - Fax:314-289-6381
Practice Address - Street 1:2727 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1421
Practice Address - Country:US
Practice Address - Phone:314-289-7659
Practice Address - Fax:314-289-6381
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009002870163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management