Healthcare Provider Details

I. General information

NPI: 1740666031
Provider Name (Legal Business Name): ROBERT ZOTTARELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PLACE
POUGHKEEPSIE NY
12607
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 845-431-5629
  • Fax:
Mailing address:
  • Phone: 571-777-5173
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6045721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: