Healthcare Provider Details

I. General information

NPI: 1962547281
Provider Name (Legal Business Name): ILANA ANN ZABLOZKI-AMIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 SHORE PKWY SUITE MADISON FF
BROOKLYN NY
11235-3956
US

IV. Provider business mailing address

3311 SHORE PARKWAY SUITE FF
BROOKLYN NY
11235-3937
US

V. Phone/Fax

Practice location:
  • Phone: 718-648-0888
  • Fax:
Mailing address:
  • Phone: 718-676-4607
  • Fax: 718-989-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number213726
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: