Healthcare Provider Details

I. General information

NPI: 1891583704
Provider Name (Legal Business Name): BRYAN ZABATTA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5418
US

IV. Provider business mailing address

28 PHOEBE ST
METHUEN MA
01844-2380
US

V. Phone/Fax

Practice location:
  • Phone: 877-442-3324
  • Fax:
Mailing address:
  • Phone: 845-389-0093
  • Fax: 845-389-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2303815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: