Healthcare Provider Details

I. General information

NPI: 1174764104
Provider Name (Legal Business Name): OMAR JESUS ZURITA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD SUITE 400
FOREST HILLS NY
11375-7200
US

IV. Provider business mailing address

11835 QUEENS BLVD STE 400
FOREST HILLS NY
11375-7211
US

V. Phone/Fax

Practice location:
  • Phone: 917-415-8764
  • Fax: 718-425-4251
Mailing address:
  • Phone: 917-415-8764
  • Fax: 877-556-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: