Healthcare Provider Details

I. General information

NPI: 1932209590
Provider Name (Legal Business Name): IRENE LOIS ZIDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CENTRAL AVE STE 202
LAWRENCE NY
11559-8507
US

IV. Provider business mailing address

290 CENTRAL AVE STE 202
LAWRENCE NY
11559-8507
US

V. Phone/Fax

Practice location:
  • Phone: 516-371-0517
  • Fax: 516-371-0519
Mailing address:
  • Phone: 516-371-0517
  • Fax: 516-371-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number151719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: