Healthcare Provider Details

I. General information

NPI: 1518183201
Provider Name (Legal Business Name): NANCY BODEN ZVONKOVIC PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PARK AVE APT. IC
NEW YORK NY
10128-1711
US

IV. Provider business mailing address

1199 PARK AVE APT. IC
NEW YORK NY
10128-1711
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-5413
  • Fax: 212-427-1677
Mailing address:
  • Phone: 212-996-5413
  • Fax: 212-427-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number68016561
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: