Basic Information
Provider Information | |||||||||
NPI: | 1568433225 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIENO | ||||||||
FirstName: | SALVATORE | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3439 | ||||||||
Address2: |   | ||||||||
City: | NORTH MYRTLE BEACH | ||||||||
State: | SC | ||||||||
PostalCode: | 295820439 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8434975929 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3361 HIGHWAY 9 E | ||||||||
Address2: |   | ||||||||
City: | LITTLE RIVER | ||||||||
State: | SC | ||||||||
PostalCode: | 295667826 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8434975929 | ||||||||
FaxNumber: | 8667789612 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/31/2006 | ||||||||
LastUpdateDate: | 03/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 29480 | IA | N |   | Allopathic & Osteopathic Physicians | Otolaryngology |   | 207Y00000X | 17722 | NE | N |   | Allopathic & Osteopathic Physicians | Otolaryngology |   | 207Y00000X | 40456 | SC | Y |   | Allopathic & Osteopathic Physicians | Otolaryngology |   |
ID Information
ID | Type | State | Issuer | Description | 1238365 | 01 | IA | FED CONTROLLED SUBSTANCE | OTHER | 94583 | 01 | IA | BLUE CROSS BLUE SHIELD | OTHER | BZ1604621N | 01 | NE | ST CONT SUBSTANCE | OTHER | 00652 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 0919548 | 05 | IA |   | MEDICAID | 1238365 | 01 | IA | ST CONT SUBSTANCE | OTHER | 404565 | 05 | SC |   | MEDICAID | BZ1604621 | 01 | NE | FED CONTROLLED SUBSTANCE | OTHER |