Healthcare Provider Details

I. General information

NPI: 1174953129
Provider Name (Legal Business Name): SALVATORE ZAVARELLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 MONTAUK HWY STE 6
WEST ISLIP NY
11795-4939
US

IV. Provider business mailing address

1175 MONTAUK HWY STE 6
WEST ISLIP NY
11795-4939
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-6066
  • Fax: 631-337-7698
Mailing address:
  • Phone: 833-666-6066
  • Fax: 631-337-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number256093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: