Provider Demographics
NPI:1669886123
Name:KORWIN, ZACHARY F
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:F
Last Name:KORWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AMADEO DR
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3186
Mailing Address - Country:US
Mailing Address - Phone:848-459-2584
Mailing Address - Fax:
Practice Address - Street 1:4949 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1613
Practice Address - Country:US
Practice Address - Phone:848-459-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11274122300000X
PADS0400121223G0001X
NJ22DI02570400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice