Healthcare Provider Details

I. General information

NPI: 1588123327
Provider Name (Legal Business Name): ZACHARIAH PHILLIP ZAFFUTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N MAIN ST
FREEPORT NY
11520-2243
US

IV. Provider business mailing address

76 WYOMING AVE
LONG BEACH NY
11561-1437
US

V. Phone/Fax

Practice location:
  • Phone: 516-377-8014
  • Fax:
Mailing address:
  • Phone: 516-589-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number320908
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: