Healthcare Provider Details

I. General information

NPI: 1417347485
Provider Name (Legal Business Name): MILLPOND MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FRANKLIN AVE L18
GARDEN CITY NY
11530-5806
US

IV. Provider business mailing address

520 FRANKLIN AVE L18
GARDEN CITY NY
11530-5806
US

V. Phone/Fax

Practice location:
  • Phone: 516-243-6424
  • Fax: 516-280-3882
Mailing address:
  • Phone: 516-243-6424
  • Fax: 516-280-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MUZAFFAR ZAI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 516-243-6424