Healthcare Provider Details

I. General information

NPI: 1518301910
Provider Name (Legal Business Name): ANTHONY ZOGHBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 RIVERSIDE DR BOX 109
NEW YORK NY
10032-1007
US

IV. Provider business mailing address

1051 RIVERSIDE DR BOX 109
NEW YORK NY
10032-1007
US

V. Phone/Fax

Practice location:
  • Phone: 646-774-6365
  • Fax: 646-774-6398
Mailing address:
  • Phone: 646-774-6365
  • Fax: 646-774-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: