Healthcare Provider Details

I. General information

NPI: 1629112552
Provider Name (Legal Business Name): ANDREW S ZAGORSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W JERICHO TPKE
HUNTINGTON NY
11743-6336
US

IV. Provider business mailing address

1473 BRIARD ST
WANTAGH NY
11793-2910
US

V. Phone/Fax

Practice location:
  • Phone: 631-549-1280
  • Fax: 631-549-1005
Mailing address:
  • Phone: 631-549-1280
  • Fax: 631-549-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0211891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: