Healthcare Provider Details

I. General information

NPI: 1487614657
Provider Name (Legal Business Name): THOMAS PAUL ZWART D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MAPLE AVE
PINE BUSH NY
12566-7120
US

IV. Provider business mailing address

PO BOX 149
PINE BUSH NY
12566
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-2420
  • Fax: 845-744-2429
Mailing address:
  • Phone: 845-744-2420
  • Fax: 845-744-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX06006-3
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: