Healthcare Provider Details

I. General information

NPI: 1174384226
Provider Name (Legal Business Name): TENZIN ZOMPA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY # E2-27
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

7901 BROADWAY # E2-27
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-2475
  • Fax: 718-334-5006
Mailing address:
  • Phone: 718-334-2475
  • Fax: 718-334-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: