Provider Demographics
NPI:1326390543
Name:LIDIA ZACHARSKI NURSE PRACTITIONER IN FAMILY HEALTH PC
Entity Type:Organization
Organization Name:LIDIA ZACHARSKI NURSE PRACTITIONER IN FAMILY HEALTH PC
Other - Org Name:CARMAN AVENUE MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRIMARY PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-280-7244
Mailing Address - Street 1:823 CARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6429
Mailing Address - Country:US
Mailing Address - Phone:516-280-7244
Mailing Address - Fax:516-280-7245
Practice Address - Street 1:823 CARMAN AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6429
Practice Address - Country:US
Practice Address - Phone:516-280-7244
Practice Address - Fax:516-280-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty