Healthcare Provider Details

I. General information

NPI: 1073594008
Provider Name (Legal Business Name): MICHELLE JEANETTE ZALAZNICK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S OYSTER BAY RD
PLAINVIEW NY
11803-3313
US

IV. Provider business mailing address

71 HOFSTRA DR
PLAINVIEW NY
11803-1814
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-6330
  • Fax:
Mailing address:
  • Phone: 516-692-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT003812-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: