Healthcare Provider Details

I. General information

NPI: 1649296500
Provider Name (Legal Business Name): JOHN L ZBOINSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MOUNTAIN TOP RD
STORMVILLE NY
12582-5532
US

IV. Provider business mailing address

29 MOUNTAIN TOP RD
STORMVILLE NY
12582-5532
US

V. Phone/Fax

Practice location:
  • Phone: 144-898-7939
  • Fax: 845-876-0218
Mailing address:
  • Phone: 914-489-8793
  • Fax: 845-876-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00089
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005181-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: