Provider Demographics
NPI:1851694822
Name:NUTONGLA, ZACHARY PO-PE
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PO-PE
Last Name:NUTONGLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CANAL ST STE 6E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3596
Mailing Address - Country:US
Mailing Address - Phone:212-925-8069
Mailing Address - Fax:
Practice Address - Street 1:264 CANAL ST STE 6E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3596
Practice Address - Country:US
Practice Address - Phone:212-925-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016519-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist