Basic Information
| Provider Information | |||||||||
| NPI: | 1982669529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZANNI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | DEPT 596 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662950041 | ||||||||
| FaxNumber: | 7083422517 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 3RD AVE | ||||||||
| Address2: | SUITE 604 | ||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322224474 | ||||||||
| FaxNumber: | 7322224472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | 25MA03786300 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | 4741706 | 05 | NJ | MEDICAID |