Healthcare Provider Details

I. General information

NPI: 1790079168
Provider Name (Legal Business Name): MICHAEL ZABLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

IV. Provider business mailing address

101 HOSPITAL RD
PATCHOGUE NY
11772-4870
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7739
  • Fax:
Mailing address:
  • Phone: 631-654-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number275836
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number275836
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number275836
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: