Healthcare Provider Details

I. General information

NPI: 1407071905
Provider Name (Legal Business Name): FERN AARON ZAGOR L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 CASTLETON AVE
STATEN ISLAND NY
10301-2028
US

IV. Provider business mailing address

339 BEACH 143RD ST
NEPONSIT NY
11694-1108
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-2225
  • Fax: 718-442-2289
Mailing address:
  • Phone: 718-634-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR016122-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: