Basic Information
| Provider Information | |||||||||
| NPI: | 1689238008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEMENETZ | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BIDDLE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197023967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028367820 | ||||||||
| FaxNumber: | 3028367826 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BIDDLE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197023967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028367820 | ||||||||
| FaxNumber: | 3028367826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2019 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C1-0025089 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.