Provider Demographics
NPI:1457392250
Name:ZORNOW, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:ZORNOW
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 1:319 S MANNING BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1743
Mailing Address - Country:US
Mailing Address - Phone:518-438-1019
Mailing Address - Fax:518-438-0981
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-438-1019
Practice Address - Fax:518-438-0981
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099024208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4S2441OtherEBCBS
P00291580OtherRAILROAD MEDICARE
1099050OtherGHI PPO
92951OtherGHI HMO
4395457OtherAETNA
10002242OtherCDPHP
24131OtherMVP
000434059007OtherBLUE SHIELD OF NORTH
P00291580OtherRAILROAD MEDICARE
4S2441OtherEBCBS