Healthcare Provider Details

I. General information

NPI: 1891894788
Provider Name (Legal Business Name): BARRY M. ZIDE M.D., D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 55TH ST SUITE 1D
NEW YORK NY
10022-5139
US

IV. Provider business mailing address

420 E 55TH ST SUITE 1D
NEW YORK NY
10022-5139
US

V. Phone/Fax

Practice location:
  • Phone: 212-421-2424
  • Fax: 212-421-2463
Mailing address:
  • Phone: 212-421-2424
  • Fax: 212-421-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number139147-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: