Healthcare Provider Details

I. General information

NPI: 1275646580
Provider Name (Legal Business Name): KENNETH A ZIPKIN DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SCHOOL ST REAR
GLEN COVE NY
11542
US

IV. Provider business mailing address

30 SCHOOL ST REAR
GLEN COVE NY
11542
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-3131
  • Fax: 516-671-3172
Mailing address:
  • Phone: 516-671-3131
  • Fax: 516-671-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number029010DDS
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: