Healthcare Provider Details

I. General information

NPI: 1811467723
Provider Name (Legal Business Name): THIAGO ANTONIO ZOGBI LIC. ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 TROUTMAN ST APT 1L
BROOKLYN NY
11237-2142
US

IV. Provider business mailing address

237 TROUTMAN ST APT 1L
BROOKLYN NY
11237-2142
US

V. Phone/Fax

Practice location:
  • Phone: 347-783-4633
  • Fax:
Mailing address:
  • Phone: 347-783-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: