Healthcare Provider Details

I. General information

NPI: 1851795694
Provider Name (Legal Business Name): JULIE ZAIDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TYRELLAN AVE
STATEN ISLAND NY
10309-2624
US

IV. Provider business mailing address

101 TYRELLAN AVE
STATEN ISLAND NY
10309-2624
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-9848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number307518-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: