Healthcare Provider Details

I. General information

NPI: 1346556461
Provider Name (Legal Business Name): SAMEERA ZICKRIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

15008 77TH RD
FLUSHING NY
11367-3423
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3280
  • Fax:
Mailing address:
  • Phone: 718-591-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0322231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: