Healthcare Provider Details

I. General information

NPI: 1043056914
Provider Name (Legal Business Name): CARLENE C ZINCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 E 72ND ST # 2
BROOKLYN NY
11234-5421
US

IV. Provider business mailing address

1127 E 72ND ST # 2
BROOKLYN NY
11234-5421
US

V. Phone/Fax

Practice location:
  • Phone: 561-414-7330
  • Fax: 631-850-6859
Mailing address:
  • Phone: 561-414-7330
  • Fax: 631-850-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number366547
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number95404390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: