Healthcare Provider Details

I. General information

NPI: 1609804400
Provider Name (Legal Business Name): GREGORY ZITO M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HEMPSTEAD AVE
MALVERNE NY
11565-1201
US

IV. Provider business mailing address

306 HEMPSTEAD AVE
MALVERNE NY
11565-1201
US

V. Phone/Fax

Practice location:
  • Phone: 516-678-1559
  • Fax: 516-764-5738
Mailing address:
  • Phone: 516-678-1559
  • Fax: 516-764-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number161504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: