Healthcare Provider Details

I. General information

NPI: 1962790279
Provider Name (Legal Business Name): THEOFANIS P ZOIS RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 UNION PL
LYNBROOK NY
11563-4126
US

IV. Provider business mailing address

110 UNION PL
LYNBROOK NY
11563-4126
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-2914
  • Fax:
Mailing address:
  • Phone: 516-599-2914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number14896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: