Healthcare Provider Details

I. General information

NPI: 1114072840
Provider Name (Legal Business Name): MAHTAB ZINATI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 57TH ST
NEW YORK NY
10019-2902
US

IV. Provider business mailing address

218 MCCLOUD DR
FORT LEE NJ
07024-5304
US

V. Phone/Fax

Practice location:
  • Phone: 212-293-3000
  • Fax:
Mailing address:
  • Phone: 201-947-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number487861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: