Healthcare Provider Details

I. General information

NPI: 1992092720
Provider Name (Legal Business Name): ZEITOUN MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E 23RD ST SECOND FLOOR
NEW YORK NY
10010-3794
US

IV. Provider business mailing address

159 W 53RD ST APT 24C
NEW YORK NY
10019-6005
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-5118
  • Fax: 212-677-5338
Mailing address:
  • Phone: 212-677-5118
  • Fax: 212-677-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number200343
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number200343
License Number StateNY

VIII. Authorized Official

Name: DR. KHALED ZEITOUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-640-5880