Healthcare Provider Details

I. General information

NPI: 1922400480
Provider Name (Legal Business Name): MICHELLE C ZINN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MALTESE DR
MIDDLETOWN NY
10940-2115
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940-2115
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-4774
  • Fax: 845-343-8741
Mailing address:
  • Phone: 845-342-4774
  • Fax: 845-343-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003396
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: