Healthcare Provider Details

I. General information

NPI: 1588492144
Provider Name (Legal Business Name): ANDRES R ZUNIGA M.ED,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 10/27/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LYMAN AVE
JOHNSTON RI
02919-2714
US

IV. Provider business mailing address

701 STATE ROUTE 440 STE 16 #1094
JERSEY CITY NJ
07304
US

V. Phone/Fax

Practice location:
  • Phone: 914-481-3262
  • Fax:
Mailing address:
  • Phone: 862-417-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: