Healthcare Provider Details

I. General information

NPI: 1043344807
Provider Name (Legal Business Name): SETH B ZEBRAK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

7004 KENNEDY BLVD E APT 32F
GUTTENBERG NJ
07093-5029
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2486
  • Fax: 973-754-2482
Mailing address:
  • Phone: 646-352-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00164100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: