Healthcare Provider Details

I. General information

NPI: 1710834387
Provider Name (Legal Business Name): ZACK POPOVICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 42ND ST APT 2R
LONG ISLAND CITY NY
11101-1216
US

IV. Provider business mailing address

3441 42ND ST APT 2R
LONG ISLAND CITY NY
11101-1216
US

V. Phone/Fax

Practice location:
  • Phone: 646-623-7927
  • Fax:
Mailing address:
  • Phone: 646-623-7927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number013346
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: