Healthcare Provider Details

I. General information

NPI: 1407197130
Provider Name (Legal Business Name): DANIELLE MARIE ZICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 02/22/2024
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TECHNOLOGY DR STE 100
EAST SETAUKET NY
11733-4079
US

IV. Provider business mailing address

6 TECHNOLOGY DR STE 100
EAST SETAUKET NY
11733-4079
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-2685
  • Fax: 631-532-4998
Mailing address:
  • Phone: 631-371-2685
  • Fax: 631-532-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: