Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 249191 | MA |
N | 208600000X | Surgeon | 249191 | MA |
Y | 2086S0120X | Pediatric Surgery | 249191 | MA |
NPI | 1174794556 |
---|---|
Provider Name | Jill M Zalieckas |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 28/10/2021 |