Healthcare Provider Details

I. General information

NPI: 1790958056
Provider Name (Legal Business Name): SANDRA FINK ZAGELBAUM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E 26TH ST
BROOKLYN NY
11210-5232
US

IV. Provider business mailing address

1453 E 26TH ST
BROOKLYN NY
11210-5232
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-2072
  • Fax: 718-486-5553
Mailing address:
  • Phone: 718-951-2072
  • Fax: 718-486-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048892
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: