Healthcare Provider Details

I. General information

NPI: 1770519977
Provider Name (Legal Business Name): ANDREW RICHARD ZAAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 OLD COUNTRY RD
PLAINVIEW NY
11803-4909
US

IV. Provider business mailing address

630 OLD COUNTRY RD
PLAINVIEW NY
11803-4909
US

V. Phone/Fax

Practice location:
  • Phone: 516-937-1121
  • Fax: 516-937-1126
Mailing address:
  • Phone: 516-937-1121
  • Fax: 516-937-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019-00955
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83125
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS4251
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number155654
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-12049
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: