=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407922198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZELIK ZIEGELBAUM RPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 05/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 MANORHAVEN BLVD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-944-8798
-----------------------------------------------------
Fax | 516-944-9354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 MANORHAVEN BLVD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-944-8798
-----------------------------------------------------
Fax | 516-944-9354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 7616
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------