Basic Information
Provider Information | |||||||||
NPI: | 1437441003 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SEMINARA-ZAMBRZYCKA | ||||||||
FirstName: | NICOLE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SEMINARA | ||||||||
OtherFirstName: | NICOLE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1072 XRAY DR | ||||||||
Address2: | SUITE B | ||||||||
City: | GASTONIA | ||||||||
State: | NC | ||||||||
PostalCode: | 28054 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7046711094 | ||||||||
FaxNumber: | 7046711095 | ||||||||
Practice Location | |||||||||
Address1: | 19900 W CATAWBA AVE # B | ||||||||
Address2: |   | ||||||||
City: | CORNELIUS | ||||||||
State: | NC | ||||||||
PostalCode: | 280314032 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7048924878 | ||||||||
FaxNumber: | 7048927453 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/13/2011 | ||||||||
LastUpdateDate: | 06/23/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/23/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 279257 | NY | N |   | Allopathic & Osteopathic Physicians | Dermatology |   | 207N00000X | 2020-00593 | NC | Y |   | Allopathic & Osteopathic Physicians | Dermatology |   |
No ID Information.