Healthcare Provider Details

I. General information

NPI: 1871206599
Provider Name (Legal Business Name): TENZIN ZOMPA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 CRESCENT ST
LONG ISLAND CITY NY
11106-3918
US

IV. Provider business mailing address

3448 CRESCENT ST
LONG ISLAND CITY NY
11106-3918
US

V. Phone/Fax

Practice location:
  • Phone: 917-257-3329
  • Fax:
Mailing address:
  • Phone: 917-257-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: