Healthcare Provider Details

I. General information

NPI: 1619064888
Provider Name (Legal Business Name): MARK P ZOLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST STE 703
NEW YORK NY
10022-1138
US

IV. Provider business mailing address

133 E 58TH ST STE 703
NEW YORK NY
10022-1138
US

V. Phone/Fax

Practice location:
  • Phone: 212-628-8771
  • Fax: 212-794-0136
Mailing address:
  • Phone: 212-628-8771
  • Fax: 212-794-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number199064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: