Provider Demographics
NPI:1649394982
Name:MICHELLE ZYGIELBAUM, INC.
Entity type:Organization
Organization Name:MICHELLE ZYGIELBAUM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-564-4040
Mailing Address - Street 1:5411 W CEDAR LN
Mailing Address - Street 2:105A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-564-4040
Mailing Address - Fax:301-564-3604
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:105A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-564-4040
Practice Address - Fax:301-564-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01040Medicare ID - Type Unspecified