Healthcare Provider Details

I. General information

NPI: 1083578595
Provider Name (Legal Business Name): ZOE BORTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 33RD AVE APT 2C
ASTORIA NY
11106-3432
US

IV. Provider business mailing address

2804 33RD AVE APT 2C
ASTORIA NY
11106-3432
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-4670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123962
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: