Healthcare Provider Details

I. General information

NPI: 1104816149
Provider Name (Legal Business Name): ARNOLD ZOMICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 5TH AVE
BROOKLYN NY
11215-5434
US

IV. Provider business mailing address

633 5TH AVE
BROOKLYN NY
11215-5434
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-6761
  • Fax: 718-499-6761
Mailing address:
  • Phone: 718-499-6761
  • Fax: 718-499-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number031204
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: