Healthcare Provider Details

I. General information

NPI: 1982879904
Provider Name (Legal Business Name): DIMITRY ZAPOLSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 ELVERTON AVE
STATEN ISLAND NY
10308-1530
US

IV. Provider business mailing address

221 ELVERTON AVE
STATEN ISLAND NY
10308
US

V. Phone/Fax

Practice location:
  • Phone: 171-833-1960
  • Fax:
Mailing address:
  • Phone: 164-634-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003694
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: