Healthcare Provider Details

I. General information

NPI: 1902255706
Provider Name (Legal Business Name): ZACHARY WILLIAM MIRSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S CONGRESS AVE
ATLANTIS FL
33462-1347
US

IV. Provider business mailing address

PO BOX 223190
HOLLYWOOD FL
33022-3190
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5533
  • Fax:
Mailing address:
  • Phone: 305-974-5533
  • Fax: 305-974-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME149111
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME149111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: