Provider Demographics
NPI:1629499694
Name:BRIGIDO-ZAVALA, NORMA V
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:V
Last Name:BRIGIDO-ZAVALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 GARNET ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2206
Mailing Address - Country:US
Mailing Address - Phone:631-586-8876
Mailing Address - Fax:
Practice Address - Street 1:590 GARNET ST
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-2206
Practice Address - Country:US
Practice Address - Phone:631-586-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103T00000XMedicaid