Healthcare Provider Details

I. General information

NPI: 1376184051
Provider Name (Legal Business Name): AMY ZAGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 17TH ST FL 2
NEW YORK NY
10003-1949
US

IV. Provider business mailing address

5 E 17TH ST FL 2
NEW YORK NY
10003-1949
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-2990
  • Fax:
Mailing address:
  • Phone: 212-989-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: