Healthcare Provider Details

I. General information

NPI: 1215284575
Provider Name (Legal Business Name): MARIA ZDYBICKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 JUNCTION BLVD
JACKSON HEIGHTS NY
11372-3828
US

IV. Provider business mailing address

3433 JUNCTION BLVD
JACKSON HEIGHTS NY
11372-3828
US

V. Phone/Fax

Practice location:
  • Phone: 718-476-7125
  • Fax:
Mailing address:
  • Phone: 718-476-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number450026 - 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: