Basic Information
| Provider Information | |||||||||
| NPI: | 1689140378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALVATORE M ZAVARELLA DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 MONTAUK HWY STE 6 | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315267126 | ||||||||
| FaxNumber: | 6318938012 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 MONTAUK HWY STE 6 | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315267126 | ||||||||
| FaxNumber: | 6318938012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2018 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | ZAVARELLA | ||||||||
| AuthorizedOfficialFirstName: | SALVATORE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6315267126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.