Healthcare Provider Details

I. General information

NPI: 1578611125
Provider Name (Legal Business Name): MARIA ZOTOS M.S.,R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20807 53RD AVE
OAKLAND GARDENS NY
11364-1110
US

IV. Provider business mailing address

20807 53RD AVE
OAKLAND GARDENS NY
11364-1110
US

V. Phone/Fax

Practice location:
  • Phone: 917-589-2121
  • Fax:
Mailing address:
  • Phone: 917-589-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number944698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: