Healthcare Provider Details

I. General information

NPI: 1063576205
Provider Name (Legal Business Name): GABOR ZOLTAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E STATE ST MAB-GPCC
GLOVERSVILLE NY
12078-1203
US

IV. Provider business mailing address

99 E STATE ST PO BOX 1250
GLOVERSVILLE NY
12078-1203
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-5691
  • Fax: 518-773-5620
Mailing address:
  • Phone: 518-775-4205
  • Fax: 518-773-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number242147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: