MEDICARE: ZACK POPOVICH

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	225700000X	Massage Therapist	013346	NY
2	225200000X	Physical Therapy Assistant	015175	NY

General Provider Information

NPI Number	:	1710834387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACK POPOVICH

Provider Business Mailing Address
First Line	:	3441 42ND ST APT 2R
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1216
Country	:	US
Telephone Number	:	646-623-7927
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 42ND ST APT 2R
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1216
Country	:	US
Telephone Number	:	646-623-7927
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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