Basic Information
Provider Information | |||||||||
NPI: | 1427014992 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZAKI | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14416 W MEEKER BLVD | ||||||||
Address2: |   | ||||||||
City: | SUN CITY WEST | ||||||||
State: | AZ | ||||||||
PostalCode: | 853755284 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6235835180 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 14416 W MEEKER BLVD | ||||||||
Address2: |   | ||||||||
City: | SUN CITY WEST | ||||||||
State: | AZ | ||||||||
PostalCode: | 853755284 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6235835180 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/25/2006 | ||||||||
LastUpdateDate: | 02/08/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 237284-1 | NY | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | P00268767 | 01 | NY | RAILROAD MEDICARE | OTHER | 00027383201 | 01 | NY | UNIVERA | OTHER | 02733773 | 05 | NY |   | MEDICAID | 000528335001 | 01 | NY | BCBS | OTHER | 0813059 | 01 | NY | IHA | OTHER | 16-1386911 | 01 | NY | TAX ID | OTHER |