Healthcare Provider Details

I. General information

NPI: 1649850553
Provider Name (Legal Business Name): MAHTAB ZANGUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1104
US

IV. Provider business mailing address

8268 164TH ST
JAMAICA NY
11432-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4583
  • Fax: 718-883-6197
Mailing address:
  • Phone: 718-883-4583
  • Fax: 718-883-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: