Provider Demographics
NPI:1619400892
Name:ZAMOR, GINETTE
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:
Last Name:ZAMOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2716
Mailing Address - Country:US
Mailing Address - Phone:631-608-8523
Mailing Address - Fax:631-608-8527
Practice Address - Street 1:365 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2716
Practice Address - Country:US
Practice Address - Phone:631-608-8523
Practice Address - Fax:631-608-8527
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325044164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse