Healthcare Provider Details

I. General information

NPI: 1891137212
Provider Name (Legal Business Name): MICHAL SZYMON ZYLINSKI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 VICTORY BLVD
STATEN ISLAND NY
10314-3514
US

IV. Provider business mailing address

128 RUSTIC PL
STATEN ISLAND NY
10308-2840
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-5000
  • Fax:
Mailing address:
  • Phone: 718-371-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008022
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: