Basic Information
| Provider Information | |||||||||
| NPI: | 1518183219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEREN | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | MARC | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | RM 310 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187331000 | ||||||||
| FaxNumber: | 7187330351 | ||||||||
| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | RM 310 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187331000 | ||||||||
| FaxNumber: | 7187330351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | X004638-1 | NY | Y | Chiropractic Providers | Chiropractor |
No ID Information.