Healthcare Provider Details

I. General information

NPI: 1407916265
Provider Name (Legal Business Name): IRVING ZOLTAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 TENBROECK AVE
BRONX NY
10461-2007
US

IV. Provider business mailing address

61 WYKAGYL TER
NEW ROCHELLE NY
10804-3207
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-9060
  • Fax: 718-828-9845
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number124441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: