Healthcare Provider Details

I. General information

NPI: 1336726223
Provider Name (Legal Business Name): JOHN ZASO DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MERRICK AVE
EAST MEADOW NY
11554-3703
US

IV. Provider business mailing address

994 W JERICHO TPKE STE 202A
SMITHTOWN NY
11787-3211
US

V. Phone/Fax

Practice location:
  • Phone: 516-794-7969
  • Fax:
Mailing address:
  • Phone: 631-670-7700
  • Fax: 631-343-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN ZASO
Title or Position: PROVIDER AND OWNER
Credential: DO
Phone: 631-670-7700