Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101030715 | VA |
N | 204C00000X | Sports Medicine Doctor | ME 84809 | FL |
NPI | 1780650101 |
---|---|
Provider Name | Andrew Czeslaw Zaleski |
First Address | Nokomis, FL 34275 |
Second Address | Nokomis, FL 34275-1755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2006 |
Last Update Date | 11/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269472700 | (05) | FL |
B83016 | (02) | NY |
P00768151 | RR MEDICARE VA (01) | VA |