Provider Demographics
NPI:1487026027
Name:Z MEDICAL NYC, P.C.
Entity Type:Organization
Organization Name:Z MEDICAL NYC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-884-0133
Mailing Address - Street 1:1702 AVENUE Z
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3655
Mailing Address - Country:US
Mailing Address - Phone:646-884-0133
Mailing Address - Fax:
Practice Address - Street 1:1702 AVENUE Z
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3655
Practice Address - Country:US
Practice Address - Phone:646-884-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144699204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042442Medicaid
NY01171NMedicare PIN