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General NPI Number Information
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NPI Number | 1134642440
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Entity Type | Individual
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Provider Name | PENELOPE ZAVERDAS DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 720 NORTHERN BLVD
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City | GREENVALE
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State | NY
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Zip | 11548-1319
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Country | US
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Telephone | 631-942-3179
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Fax |
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Provider Business Mailing Address
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Address Line | 12 FISHER RD
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City | COMMACK
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State | NY
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Zip | 11725-5303
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Country | US
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Telephone | 631-942-3179
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 050870
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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