Healthcare Provider Details

I. General information

NPI: 1568299212
Provider Name (Legal Business Name): JACQUELINE MARIE ZEANKOWSKI ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OAK ST
PATCHOGUE NY
11772-2841
US

IV. Provider business mailing address

576 WASHINGTON AVE
LINDENHURST NY
11757-5344
US

V. Phone/Fax

Practice location:
  • Phone: 631-629-2250
  • Fax:
Mailing address:
  • Phone: 631-471-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number003032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: