Healthcare Provider Details

I. General information

NPI: 1013558444
Provider Name (Legal Business Name): ZEN MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 STEWART AVE
GARDEN CITY NY
11530-4771
US

IV. Provider business mailing address

7313 MOCKINGBIRD LANE
WAXHAW NC
28173
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-3355
  • Fax:
Mailing address:
  • Phone: 917-415-8420
  • Fax: 929-214-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DEMETRIOUS
Title or Position: MD
Credential: MD
Phone: 516-650-3355