Healthcare Provider Details

I. General information

NPI: 1699612366
Provider Name (Legal Business Name): ZACHARY ZIMBARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 LIBERTY VIEW LN
LYNCHBURG VA
24502-2291
US

IV. Provider business mailing address

41 BRADLEY RD
SCARSDALE NY
10583-5721
US

V. Phone/Fax

Practice location:
  • Phone: 434-592-6400
  • Fax:
Mailing address:
  • Phone: 914-519-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number951315317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: