Provider Demographics
NPI:1649249368
Name:ZUGIBE, FREDERICK T JR (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:T
Last Name:ZUGIBE
Suffix:JR
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 1:201 FREY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1015
Mailing Address - Country:US
Mailing Address - Phone:315-331-4344
Mailing Address - Fax:315-331-1211
Practice Address - Street 1:201 FREY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1015
Practice Address - Country:US
Practice Address - Phone:315-331-4344
Practice Address - Fax:315-331-1211
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139325207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70556OtherBC/BS ROCHESTER
NY100873BOOtherPREFERRED HEALTH
NYP150139325OtherBLUE CHOICE
NY00778212Medicaid
NY100873BOOtherPREFERRED HEALTH
NYB75589Medicare UPIN