Healthcare Provider Details

I. General information

NPI: 1124330105
Provider Name (Legal Business Name): DIONY P ZAMORA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E 54TH ST APT. 26 C
NEW YORK NY
10022-4810
US

IV. Provider business mailing address

250 E 54TH ST APT. 26 C
NEW YORK NY
10022-4810
US

V. Phone/Fax

Practice location:
  • Phone: 917-847-4375
  • Fax:
Mailing address:
  • Phone: 917-847-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number013880
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: