Provider Demographics
NPI:1770770497
Name:JOHN S ZAVACKI, M.D.,P.C.
Entity type:Organization
Organization Name:JOHN S ZAVACKI, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAVACKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-829-0031
Mailing Address - Street 1:216 N RIVER ST
Mailing Address - Street 2:SUITE 640 COURTHOUSE SQUARE TOWERS
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2532
Mailing Address - Country:US
Mailing Address - Phone:570-829-0031
Mailing Address - Fax:570-829-0158
Practice Address - Street 1:216 N RIVER ST
Practice Address - Street 2:SUITE 640 COURTHOUSE SQUARE TOWERS
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2532
Practice Address - Country:US
Practice Address - Phone:570-829-0031
Practice Address - Fax:570-829-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009136-E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZA1635348OtherHIGHMARK BLUE SHIELD