Basic Information
| Provider Information | |||||||||
| NPI: | 1558824052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAKON | ||||||||
| FirstName: | MEREDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 LOCUST AVE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024215831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814245571 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST STE 1100 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228585 | ||||||||
| FaxNumber: | 5859228555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 023496 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | STUDENT | 01 | STUDENT | OTHER |