MEDICARE: DR. SANDRA FINK ZAGELBAUM DDS

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	048892	NY

General Provider Information

NPI Number	:	1790958056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA FINK ZAGELBAUM DDS

Provider Business Mailing Address
First Line	:	1453 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5232
Country	:	US
Telephone Number	:	718-951-2072
Fax Number	:	718-486-5553

Provider Business Practice Location Address
First Line	:	1453 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5232
Country	:	US
Telephone Number	:	718-951-2072
Fax Number	:	718-486-5553

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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