MEDICARE: AMIRA ZACHARY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02796600	NJ

General Provider Information

NPI Number	:	1134626443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRA ZACHARY

Provider Business Mailing Address
First Line	:	38 BOGERT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5677
Country	:	US
Telephone Number	:	917-602-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MILLBURN AVE STE 207
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1935
Country	:	US
Telephone Number	:	917-602-8442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	03/23/2026

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Directions to “ AMIRA ZACHARY ” Practice Location

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