Healthcare Provider Details

I. General information

NPI: 1174130694
Provider Name (Legal Business Name): JUDA ZURNDORFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

21 CIVIC CENTER DR APT 3
EAST BRUNSWICK NJ
08816-3573
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9000
  • Fax:
Mailing address:
  • Phone: 347-978-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number431860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: