Provider Demographics
NPI:1275620742
Name:ZEV CARROLL MD PC
Entity Type:Organization
Organization Name:ZEV CARROLL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEV
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-569-6828
Mailing Address - Street 1:1025 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1633
Mailing Address - Country:US
Mailing Address - Phone:516-569-6828
Mailing Address - Fax:516-569-6828
Practice Address - Street 1:14449 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1713
Practice Address - Country:US
Practice Address - Phone:718-353-2975
Practice Address - Fax:516-569-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170636207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF33646Medicare UPIN
NY00504Medicare ID - Type Unspecified