Healthcare Provider Details

I. General information

NPI: 1558378935
Provider Name (Legal Business Name): CHARLES M ZAROFF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 40TH ST STE 607
NEW YORK NY
10016-1801
US

IV. Provider business mailing address

104 E 40TH ST STE 607
NEW YORK NY
10016-1801
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-8511
  • Fax: 212-726-7417
Mailing address:
  • Phone: 212-725-8511
  • Fax: 212-726-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number015052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: