Provider Demographics
NPI:1154509776
Name:DR BRUCE A ZAPPIA DPM
Entity Type:Organization
Organization Name:DR BRUCE A ZAPPIA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAPPIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-893-9227
Mailing Address - Street 1:575 DEAR PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-893-9227
Mailing Address - Fax:631-893-6521
Practice Address - Street 1:575 DEAR PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-893-9227
Practice Address - Fax:631-893-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005183213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692135Medicaid
NYU55993Medicare UPIN
NY4420900001Medicare NSC