Basic Information
Provider Information
NPI: 1932727237
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EMROCK
FirstName: ZACHARY
MiddleName: JOSEPH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1401 DEER XING
Address2:  
City: VALLEY CITY
State: OH
PostalCode: 442809446
CountryCode: US
TelephoneNumber: 3306351910
FaxNumber:  
Practice Location
Address1: 141 N FORGE ST
Address2:  
City: AKRON
State: OH
PostalCode: 443041407
CountryCode: US
TelephoneNumber: 3303753000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/13/2020
LastUpdateDate: 07/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN.418101OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home