Healthcare Provider Details

I. General information

NPI: 1376591529
Provider Name (Legal Business Name): NICHOLAS P ZOTTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 JOHN ST
BABYLON NY
11702-2932
US

IV. Provider business mailing address

213 MONTAUK HWY
WEST SAYVILLE NY
11796-1800
US

V. Phone/Fax

Practice location:
  • Phone: 631-893-4355
  • Fax: 631-563-7718
Mailing address:
  • Phone: 631-563-6205
  • Fax: 631-563-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: