Provider Demographics
NPI:1457801201
Name:ZEIGLER, AMBER
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:
Last Name:ZEIGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N 3RD ST
Mailing Address - Street 2:PMB 770
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 N 3RD ST
Practice Address - Street 2:PMB 770
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2904
Practice Address - Country:US
Practice Address - Phone:267-761-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA640899171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
16747680OtherNATIONAL PRODUCER NUMBER
PA53057OtherFFM #