Healthcare Provider Details

I. General information

NPI: 1679923395
Provider Name (Legal Business Name): EITAN ZERYKIER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 CENTRAL AVE UNIT A
CEDARHURST NY
11516-2051
US

IV. Provider business mailing address

769 WILSON ST
VALLEY STREAM NY
11581-3527
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax:
Mailing address:
  • Phone: 347-868-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097559
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088836-01
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: