Provider Demographics
NPI:1639109531
Name:ZAKUTNY, EMIL (DSW)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:ZAKUTNY
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1852
Mailing Address - Country:US
Mailing Address - Phone:516-868-3421
Mailing Address - Fax:516-623-3644
Practice Address - Street 1:865 MERRICK RD STE 305
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3338
Practice Address - Country:US
Practice Address - Phone:516-868-3421
Practice Address - Fax:516-623-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0293501041C0700X
NY000547-1106H00000X
NY5284101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN46852Medicare PIN