Healthcare Provider Details

I. General information

NPI: 1316244429
Provider Name (Legal Business Name): M. DAPHNE ZAGORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY DAPHNE ZAGORSKI RN

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 NORWOOD AVE
NORTHPORT NY
11768-1958
US

IV. Provider business mailing address

109 NORWOOD AVE
NORTHPORT NY
11768-1958
US

V. Phone/Fax

Practice location:
  • Phone: 631-754-7003
  • Fax:
Mailing address:
  • Phone: 631-754-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number487732-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: