Healthcare Provider Details

I. General information

NPI: 1205600194
Provider Name (Legal Business Name): ZR ZIEGELBAUM RPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MANORHAVEN BLVD
PORT WASHINGTON NY
11050-1608
US

IV. Provider business mailing address

26 MANORHAVEN BLVD
PORT WASHINGTON NY
11050-1608
US

V. Phone/Fax

Practice location:
  • Phone: 516-944-8798
  • Fax: 516-944-9354
Mailing address:
  • Phone: 516-944-8798
  • Fax: 516-944-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT ZIEGELBAUM
Title or Position: OWNER/PARTNER
Credential: DPT
Phone: 516-944-8798