Provider Demographics
NPI:1194861799
Name:ZWEIGHAFT, MARY (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:ZWEIGHAFT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1320
Mailing Address - Country:US
Mailing Address - Phone:845-359-4915
Mailing Address - Fax:
Practice Address - Street 1:575 W 181ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5002
Practice Address - Country:US
Practice Address - Phone:212-342-3060
Practice Address - Fax:121-342-6010
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380050363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics