Healthcare Provider Details

I. General information

NPI: 1902131410
Provider Name (Legal Business Name): DR. LAWRENCE HERBERT ZINGESSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 10/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 COVE RD
MAMARONECK NY
10543-4324
US

IV. Provider business mailing address

752 COVE RD
MAMARONECK NY
10543-4324
US

V. Phone/Fax

Practice location:
  • Phone: 914-777-7348
  • Fax: 914-777-7348
Mailing address:
  • Phone: 914-777-7348
  • Fax: 914-777-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number078519-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number078519-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number078519-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number078519-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: