Healthcare Provider Details

I. General information

NPI: 1255427506
Provider Name (Legal Business Name): JUAN C. ZAPATA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
EAST PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

250 PATCHOGUE YAPHANK RD SUITE 3
EAST PATCHOGUE NY
11772-4800
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-7680
  • Fax: 631-475-7683
Mailing address:
  • Phone: 631-475-7680
  • Fax: 631-475-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number224931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: