Basic Information
Provider Information
NPI: 1417179888
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZOBAY
FirstName: ALLEN
MiddleName: JOSEPH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8596551100
FaxNumber: 8596551102
Practice Location
Address1: 1500 JAMES SIMPSON JR WAY
Address2:  
City: COVINGTON
State: KY
PostalCode: 410110801
CountryCode: US
TelephoneNumber: 8596551100
FaxNumber: 8596551102
Other Information
ProviderEnumerationDate: 05/03/2007
LastUpdateDate: 09/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X26260KYY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
P0096092201KYRAILROAD MEDICAREOTHER
015847605OH MEDICAID
6478999305KY MEDICAID


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