Provider Demographics
NPI:1558378935
Name:ZAROFF, CHARLES M (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:ZAROFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E 40TH ST
Mailing Address - Street 2:STE 607
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1801
Mailing Address - Country:US
Mailing Address - Phone:212-725-8511
Mailing Address - Fax:212-726-7417
Practice Address - Street 1:104 E 40TH ST
Practice Address - Street 2:STE 607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-725-8511
Practice Address - Fax:212-726-7417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015052103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2802548Medicaid
NY2802548Medicaid
Q46956Medicare UPIN