Healthcare Provider Details

I. General information

NPI: 1992009666
Provider Name (Legal Business Name): JONATHAN ZAGZAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTHERN BLVD
GREENVALE NY
11548-1219
US

IV. Provider business mailing address

2200 NORTHERN BLVD
GREENVALE NY
11548-1219
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-5262
  • Fax:
Mailing address:
  • Phone: 516-627-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR3251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: