Healthcare Provider Details

I. General information

NPI: 1205970217
Provider Name (Legal Business Name): HEALTHGUARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BEACH 95TH ST
ROCKAWAY BEACH NY
11693-1303
US

IV. Provider business mailing address

217 BEACH 95TH ST
ROCKAWAY BEACH NY
11693-1303
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-9384
  • Fax: 718-318-8866
Mailing address:
  • Phone: 718-634-9384
  • Fax: 718-318-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number7003258R
License Number StateNY

VIII. Authorized Official

Name: ESTHER ZEIDMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-634-9384