Healthcare Provider Details

I. General information

NPI: 1558452730
Provider Name (Legal Business Name): YECHIEL ZAGELBAUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WALLABOUT ST APT 3C
BROOKLYN NY
11206-5541
US

IV. Provider business mailing address

1453 EAST 26TH ST.
BROOKLYN NY
11210
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-9800
  • Fax: 718-486-5553
Mailing address:
  • Phone: 718-486-9800
  • Fax: 718-486-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: