Provider Demographics
NPI:1073611018
Name:ZABARKO, DIANA S (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:S
Last Name:ZABARKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 RATZER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:917-327-3811
Mailing Address - Fax:973-904-3339
Practice Address - Street 1:2703 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3721
Practice Address - Country:US
Practice Address - Phone:201-866-2011
Practice Address - Fax:201-866-2012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00124001152W00000X
NJ27T000124001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9131809Medicaid
NJ184700Medicare PIN
NJU94302Medicare UPIN