Healthcare Provider Details

I. General information

NPI: 1750760062
Provider Name (Legal Business Name): CLARA TZAU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 LIVINGSTON ST APT 6
BROOKLYN NY
11201-4843
US

IV. Provider business mailing address

71 PARK AVE APT PHA
NEW YORK NY
10016-2507
US

V. Phone/Fax

Practice location:
  • Phone: 646-255-9014
  • Fax:
Mailing address:
  • Phone: 646-255-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number057001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: