Healthcare Provider Details

I. General information

NPI: 1982761888
Provider Name (Legal Business Name): ZEBULON CHARLES TAINTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E 93RD ST
NEW YORK NY
10128-1928
US

IV. Provider business mailing address

19 E 93RD ST
NEW YORK NY
10128-1928
US

V. Phone/Fax

Practice location:
  • Phone: 917-861-7696
  • Fax:
Mailing address:
  • Phone: 917-861-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number91418
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number91418
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number91418
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: