Healthcare Provider Details

I. General information

NPI: 1548545270
Provider Name (Legal Business Name): ZEINA ZOOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 MYRTLE AVE
RIDGEWOOD NY
11385-3550
US

IV. Provider business mailing address

5535 MYRTLE AVE
RIDGEWOOD NY
11385-3550
US

V. Phone/Fax

Practice location:
  • Phone: 347-889-7094
  • Fax: 347-889-7093
Mailing address:
  • Phone: 347-889-7094
  • Fax: 347-889-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number009212-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: