Healthcare Provider Details

I. General information

NPI: 1457603391
Provider Name (Legal Business Name): MICHELLE ZHUBRAK DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ZOE ST APT 3M
STATEN ISLAND NY
10305-1129
US

IV. Provider business mailing address

175 ZOE ST APT 3M
STATEN ISLAND NY
10305-1129
US

V. Phone/Fax

Practice location:
  • Phone: 347-901-3547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN006620-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: