Healthcare Provider Details

I. General information

NPI: 1639270788
Provider Name (Legal Business Name): KENNETH HOWARD ZATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MIDLAND AVE SUITE 2A
NYACK NY
10960-1627
US

IV. Provider business mailing address

311 N MIDLAND AVE SUITE 2A
NYACK NY
10960-1627
US

V. Phone/Fax

Practice location:
  • Phone: 845-353-7360
  • Fax: 845-353-7362
Mailing address:
  • Phone: 845-353-7360
  • Fax: 845-353-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number166695
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01132627
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: