Healthcare Provider Details

I. General information

NPI: 1770152654
Provider Name (Legal Business Name): ZENA MOURABET DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 02/09/2024
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL DRIVE
PART JEFFERSON STATION NY
11776
US

IV. Provider business mailing address

8 MEDICAL DRIVE
PART JEFFERSON STATION NY
11776
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-8585
  • Fax: 631-509-0334
Mailing address:
  • Phone: 631-928-8585
  • Fax: 631-509-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number063248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: