Healthcare Provider Details

I. General information

NPI: 1922492065
Provider Name (Legal Business Name): RUBEN D ZORRILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 REGINA AVE # 1
FAR ROCKAWAY NY
11691-2434
US

IV. Provider business mailing address

2311 REGINA AVE # 1
FAR ROCKAWAY NY
11691-2434
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-1702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number094279-1
License Number StateNY

VIII. Authorized Official

Name: RUBEN D ZORRILLA
Title or Position: PSYCHOTHERAPIST
Credential:
Phone: 718-954-1702