Healthcare Provider Details

I. General information

NPI: 1790773422
Provider Name (Legal Business Name): SUSAN ZONA-O'BYRNE M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 ROSE AVE
STATEN ISLAND NY
10306-2242
US

IV. Provider business mailing address

98 ROSE AVE
STATEN ISLAND NY
10306-2242
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-9800
  • Fax: 646-867-2121
Mailing address:
  • Phone: 718-351-9800
  • Fax: 646-867-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number194414
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: