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Provider Information for 1174794556

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

JILL M ZALIECKAS M.D.

Gender: FEMALE

Individual NPI: 1174794556

Calendar   Last Updated:  2021-10-28
  Certification Date:  2021-10-28

Details

Name Value
NPI 1174794556
Enumeration Date 2008-03-13
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE FEGAN 3
BOSTON, MA 02115-5724
United States

Phone: 617-355-1838 | Fax: 617-730-0477
View Map External Link
Primary Practice Address 300 LONGWOOD AVE FEGAN 3
BOSTON, MA 02115-5724
United States

Phone: 617-355-1838 | Fax: 617-730-0477
View Map External Link
Secondary Practice Address 725 ALBANY STREET 8C
BOSTON, MA 02118
United States

Phone: 617-414-5131 | Fax: 617-414-3806
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2086S0120X - Surgery Pediatric Surgery MA 249191
No 208600000X - Surgery MA 249191