Provider Demographics
NPI:1013014661
Name:ZARETSKY, DORA (MD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:ZARETSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 750811
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-0811
Mailing Address - Country:US
Mailing Address - Phone:718-938-8478
Mailing Address - Fax:718-997-1290
Practice Address - Street 1:7136 110TH ST
Practice Address - Street 2:STE 1H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4850
Practice Address - Country:US
Practice Address - Phone:718-938-8478
Practice Address - Fax:718-997-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2132762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01983086Medicaid
NY01983086Medicaid