Healthcare Provider Details

I. General information

NPI: 1306091830
Provider Name (Legal Business Name): JESSENIA IVELISSE ZAPATA MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9052 BORKEL PL 1ST FLOOR
QUEENS VILLAGE NY
11428-1319
US

IV. Provider business mailing address

7000 AUSTIN ST
FOREST HILLS NY
11375-1022
US

V. Phone/Fax

Practice location:
  • Phone: 516-424-2215
  • Fax:
Mailing address:
  • Phone: 516-424-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: