Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 300286 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 300286 | NY |
NPI | 1134560469 |
---|---|
Provider Name | Dr. Zachary D Vredenburgh |
First Address | East Syracuse, NY 13057-4282 |
Second Address | East Syracuse, NY 13057-4282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 10/12/2019 |