Provider Demographics
NPI:1396747556
Name:ZYGAWSKI, MARCIN MAREK (MD)
Entity type:Individual
Prefix:
First Name:MARCIN
Middle Name:MAREK
Last Name:ZYGAWSKI
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 1:740 WILLIAMS ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7463
Mailing Address - Country:US
Mailing Address - Phone:413-445-4564
Mailing Address - Fax:413-448-2727
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:SUITE #3
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-445-4564
Practice Address - Fax:413-448-2727
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231111-1174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101090936 0001Medicaid
MA110103937AMedicaid
MA110103937AMedicaid
NY101090936 0001Medicaid
NYI04325Medicare UPIN