Healthcare Provider Details

I. General information

NPI: 1700462173
Provider Name (Legal Business Name): AMARACHI CHINEDUM ZACHARIAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 05/31/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

439 WINTHROP ST
BROOKLYN NY
11203-1514
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2426
  • Fax:
Mailing address:
  • Phone: 347-677-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number329484
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: