Healthcare Provider Details

I. General information

NPI: 1053466177
Provider Name (Legal Business Name): DEBRA TYMUS ZIZIK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1 MUNSSEE CT
STONY POINT NY
10980-3440
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-7599
  • Fax: 212-523-6431
Mailing address:
  • Phone: 845-947-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number014119-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: