Healthcare Provider Details

I. General information

NPI: 1841257052
Provider Name (Legal Business Name): FREDERICK G ZAPPALA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PORT WASHINGTON UFSD 100 CAMPUS DR
PORT WASHINGTON NY
11050
US

IV. Provider business mailing address

2238 DOGWOOD LN
WESTBURY NY
11590-6022
US

V. Phone/Fax

Practice location:
  • Phone: 516-767-5975
  • Fax:
Mailing address:
  • Phone: 516-997-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number156-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00117400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: