Healthcare Provider Details

I. General information

NPI: 1548779861
Provider Name (Legal Business Name): TONY GEBRAN ZREIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

10 BRECKENRIDGE CT
HAMDEN CT
06514-1529
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number033379
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number033379
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: