Healthcare Provider Details

I. General information

NPI: 1780297176
Provider Name (Legal Business Name): JACOB ZAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 JOHNSON AVE
BOHEMIA NY
11716-2686
US

IV. Provider business mailing address

606 JOHNSON AVE
BOHEMIA NY
11716-2686
US

V. Phone/Fax

Practice location:
  • Phone: 631-503-1539
  • Fax:
Mailing address:
  • Phone: 631-503-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106631-01
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: