Healthcare Provider Details

I. General information

NPI: 1992127245
Provider Name (Legal Business Name): STEPHANIE ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date: 02/24/2020
Reactivation Date: 03/11/2020

III. Provider practice location address

538 BROADHOLLOW RD SUITE 202
MELVILLE NY
11747-3676
US

IV. Provider business mailing address

3114 NEW LONDON AVE
MEDFORD NY
11763-1762
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax:
Mailing address:
  • Phone: 631-741-9984
  • Fax: 631-385-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: