Provider Demographics
NPI:1346647625
Name:ZAKEN, GRACE AMBROSE (EDD, COMS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:AMBROSE
Last Name:ZAKEN
Suffix:
Gender:F
Credentials:EDD, COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 KRETCH CIR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5319
Mailing Address - Country:US
Mailing Address - Phone:845-896-1152
Mailing Address - Fax:
Practice Address - Street 1:61 KRETCH CIR
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5319
Practice Address - Country:US
Practice Address - Phone:845-896-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency