=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992092720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEITOUN MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2011
-----------------------------------------------------
Last Update Date | 06/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 E 23RD ST SECOND FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-677-5118
-----------------------------------------------------
Fax | 212-677-5338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 W 53RD ST APT 24C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-6005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-677-5118
-----------------------------------------------------
Fax | 212-677-5338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KHALED ZEITOUN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-640-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 200343
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0006X
-----------------------------------------------------
Taxonomy Name | Ambulatory Fertility Facility
-----------------------------------------------------
License Number | 200343
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------