Healthcare Provider Details

I. General information

NPI: 1063403863
Provider Name (Legal Business Name): ZAW ZAW AYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N HAMILTON ST HUDSON RIVER HEALTHCARE, INC.
POUGHKEEPSIE NY
12601-2541
US

IV. Provider business mailing address

1037 MAIN ST HUDSON RIVER HEALTHCARE, INC.
PEEKSKILL NY
10566-2913
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-8204
  • Fax: 845-454-8247
Mailing address:
  • Phone: 914-734-8800
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: