Healthcare Provider Details

I. General information

NPI: 1568279149
Provider Name (Legal Business Name): ZANETA SZPAKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 LINCOLN AVE
STATEN ISLAND NY
10306-2437
US

IV. Provider business mailing address

58 LINCOLN AVE
STATEN ISLAND NY
10306-2437
US

V. Phone/Fax

Practice location:
  • Phone: 347-578-0644
  • Fax:
Mailing address:
  • Phone: 347-578-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: