Healthcare Provider Details

I. General information

NPI: 1497548838
Provider Name (Legal Business Name): ADHAM ZIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 BENNETT ST
NORTH TONAWANDA NY
14120-4102
US

IV. Provider business mailing address

356 BENNETT ST
NORTH TONAWANDA NY
14120-4102
US

V. Phone/Fax

Practice location:
  • Phone: 716-550-9697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: