Healthcare Provider Details

I. General information

NPI: 1841468337
Provider Name (Legal Business Name): MIRIAM TANJA ZINCKE MPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 JACKSON ST APT 3
BROOKLYN NY
11211-2443
US

IV. Provider business mailing address

148 JACKSON ST APT 3
BROOKLYN NY
11211-2443
US

V. Phone/Fax

Practice location:
  • Phone: 646-319-9394
  • Fax:
Mailing address:
  • Phone: 646-319-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number246842-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: