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General NPI Number Information
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NPI Number | 1093232357
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Entity Type | Individual
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Provider Name | LEA MICHELLE ZELLERS MS ED, MS SPED
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 5 CRESCENT ST
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City | MASTIC
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State | NY
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Zip | 11950-1801
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Country | US
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Telephone | 631-922-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 10818 QUEENS BLVD STE 4A
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City | FOREST HILLS
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State | NY
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Zip | 11375-4748
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2529567
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License Number State | NY
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