Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 25MA07256800 | NJ |
Y | 207SG0201X | Clinical Genetics (M.D.) | MD014103E | PA |
N | 208000000X | Pediatrician | 25MA07256800 | NJ |
N | 208000000X | Pediatrician | MD014103E | PA |
NPI | 1811904881 |
---|---|
Provider Name | Elaine H Zackai |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000665287 | (05) | PA |
0328600 | (05) | NJ |
C32776 | (02) |