Provider Demographics
NPI:1538353826
Name:THEODORE ZANKER, M.D., PC
Entity type:Organization
Organization Name:THEODORE ZANKER, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-9444
Mailing Address - Street 1:315 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3715
Mailing Address - Country:US
Mailing Address - Phone:203-562-9444
Mailing Address - Fax:203-562-2360
Practice Address - Street 1:315 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3715
Practice Address - Country:US
Practice Address - Phone:203-562-9444
Practice Address - Fax:203-562-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83896Medicare UPIN