Provider Demographics
NPI:1124198643
Name:ZELLER, BARBARA CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:CAROL
Last Name:ZELLER
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 1:762 RIVERSIDE DR
Mailing Address - Street 2:6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1003
Mailing Address - Country:US
Mailing Address - Phone:917-507-2992
Mailing Address - Fax:718-508-1001
Practice Address - Street 1:1401 DR MARTIN L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-4050
Practice Address - Country:US
Practice Address - Phone:718-681-8700
Practice Address - Fax:718-508-1001
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA112697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB127667Medicare UPIN
NY00204146Medicare ID - Type Unspecified