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General NPI Number Information
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NPI Number | 1457839243
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Entity Type | Organization
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Legal Business Name | DORA ZARETSKY MEDICAL P.C.
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 98120 QUEENS BLVD STE 1C
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City | REGO PARK
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State | NY
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Zip | 11374-4414
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Country | US
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Telephone | 718-830-0246
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Fax | 718-830-0246
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Provider Business Mailing Address
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Address Line | 98120 QUEENS BLVD STE 1C
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City | REGO PARK
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State | NY
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Zip | 11374-4414
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Country | US
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Telephone | 718-830-0246
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Fax | 718-830-0246
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Authorized Official
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Title or Position | ADMINISTRATIVE
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Name | MS. MARY BUTNER
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Credential |
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Telephone | 718-830-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 213276-1
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License Number State | NY
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