Healthcare Provider Details

I. General information

NPI: 1255461109
Provider Name (Legal Business Name): RYAN J ZAPATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MANOR PL
GREENPORT NY
11944-1222
US

IV. Provider business mailing address

201 MANOR PL
GREENPORT NY
11944-1222
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-5427
  • Fax: 631-477-5822
Mailing address:
  • Phone: 631-477-5427
  • Fax: 631-477-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number217803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: