Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 030910 | CT |
NPI | 1003828435 |
---|---|
Provider Name | Dr. Cathy J Zack |
First Address | Farmington, CT 06032-2573 |
Second Address | East Hampton, CT 06424-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 04/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F15983 | (02) | CT |