Healthcare Provider Details

I. General information

NPI: 1669597761
Provider Name (Legal Business Name): LISA ROBIN ZOLLMAN MA CCC A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 SAINT NICHOLAS AVE
RIDGEWOOD NY
11385-2296
US

IV. Provider business mailing address

311 SAINT NICHOLAS AVE
RIDGEWOOD NY
11385-2296
US

V. Phone/Fax

Practice location:
  • Phone: 718-416-3277
  • Fax:
Mailing address:
  • Phone: 718-416-3277
  • Fax: 718-456-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0012261
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number001226-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: