Healthcare Provider Details

I. General information

NPI: 1982136016
Provider Name (Legal Business Name): IVAN JOSEPH ZAPOLSKY M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TECHNOLOGY DR STE 12
EAST SETAUKET NY
11733-3469
US

IV. Provider business mailing address

14 TECHNOLOGY DR STE 12
EAST SETAUKET NY
11733-3469
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4233
  • Fax: 631-444-4217
Mailing address:
  • Phone: 631-444-4233
  • Fax: 631-444-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number316752
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number316752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: