Healthcare Provider Details

I. General information

NPI: 1174080360
Provider Name (Legal Business Name): YASMIN ZOMAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

1983 SEDGWICK AVE APT 2E
BRONX NY
10453-2739
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5000
  • Fax:
Mailing address:
  • Phone: 732-788-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number023306
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: