Healthcare Provider Details

I. General information

NPI: 1457677304
Provider Name (Legal Business Name): ZAIN A YASIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 04/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 1ST AVE
NEW YORK NY
10009-3720
US

IV. Provider business mailing address

564 PONTIAC RD
EAST MEADOW NY
11554-5417
US

V. Phone/Fax

Practice location:
  • Phone: 212-253-8686
  • Fax: 212-253-2415
Mailing address:
  • Phone: 516-557-3467
  • Fax: 212-253-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number380101061153210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: