Provider Demographics
NPI:1376626994
Name:ZABALA, PRISCILA SIAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILA
Middle Name:SIAGAN
Last Name:ZABALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:189 REID AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-667-5128
Mailing Address - Fax:718-667-5128
Practice Address - Street 1:614 LOUISIANA AVE
Practice Address - Street 2:SUITE I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239
Practice Address - Country:US
Practice Address - Phone:718-942-1380
Practice Address - Fax:718-942-1380
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361995Medicaid
NY00361995Medicaid
NYB11126Medicare UPIN