Healthcare Provider Details

I. General information

NPI: 1457839243
Provider Name (Legal Business Name): DORA ZARETSKY MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD STE 1C
REGO PARK NY
11374-4414
US

IV. Provider business mailing address

98120 QUEENS BLVD STE 1C
REGO PARK NY
11374-4414
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax: 718-830-0246
Mailing address:
  • Phone: 718-830-0246
  • Fax: 718-830-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number213276-1
License Number StateNY

VIII. Authorized Official

Name: MS. MARY BUTNER
Title or Position: ADMINISTRATIVE
Credential:
Phone: 718-830-0246