Basic Information
| Provider Information | |||||||||
| NPI: | 1003011362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIEMBA | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PIGNATELLI | ||||||||
| OtherFirstName: | JEAN | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1113 N GLENCOVE RD | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132062302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154338546 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25 CHAUCER CIR | ||||||||
| Address2: | |||||||||
| City: | BALDWINSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130278254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156351517 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374T00000X | 512062-1 | NY | Y | Nursing Service Related Providers | Religious Nonmedical Nursing Personnel |
ID Information
| ID | Type | State | Issuer | Description | 02721497 | 05 | NY | MEDICAID |