Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 000196 | CT |
NPI | 1083734859 |
---|---|
Provider Name | Dr. George P. Zabrecky |
First Address | Villanova, PA 19085-1527 |
Second Address | Villanova, PA 19085-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 25/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T23474 | (02) | CT |