Healthcare Provider Details

I. General information

NPI: 1255809216
Provider Name (Legal Business Name): MIKAELA TEREZ ZUMMO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 E HARRISON ST
LONG BEACH NY
11561-2444
US

IV. Provider business mailing address

563 E HARRISON ST
LONG BEACH NY
11561-2444
US

V. Phone/Fax

Practice location:
  • Phone: 516-639-3769
  • Fax:
Mailing address:
  • Phone: 516-639-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: