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General NPI Number Information
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NPI Number | 1720884489
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Entity Type | Organization
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Legal Business Name | FOUNTAIN NYC MEDICINE PLLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 425 E 86TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10028-6491
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Country | US
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Telephone | 818-421-0242
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Fax | 917-677-8644
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Provider Business Mailing Address
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Address Line | 425 E 86TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10028-6491
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Country | US
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Telephone | 818-421-0242
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Fax | 917-677-8644
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOREEN ZARFATI
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Credential | MD
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Telephone | 818-421-0242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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