Provider Demographics
NPI:1922416205
Name:KZARK MEDICAL P.C.
Entity Type:Organization
Organization Name:KZARK MEDICAL P.C.
Other - Org Name:ADVANCED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KONSTANTINOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARKADAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-613-5875
Mailing Address - Street 1:PO BOX 5549
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-5549
Mailing Address - Country:US
Mailing Address - Phone:718-626-2222
Mailing Address - Fax:718-626-4962
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2000
Practice Address - Country:US
Practice Address - Phone:718-626-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty