Healthcare Provider Details

I. General information

NPI: 1952610099
Provider Name (Legal Business Name): STEPHEN G ZOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WOODBURY RD SUITE I(LETTERI)
WOODBURY NY
11797-2503
US

IV. Provider business mailing address

800 WOODBURY RD SUITE I(LETTERI)
WOODBURY NY
11797-2503
US

V. Phone/Fax

Practice location:
  • Phone: 516-692-3614
  • Fax:
Mailing address:
  • Phone: 516-692-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number116744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: