Provider Demographics
NPI:1942355060
Name:ZAHTZ, GERALD DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:DANIEL
Last Name:ZAHTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1121
Mailing Address - Country:US
Mailing Address - Phone:718-470-7550
Mailing Address - Fax:718-470-4514
Practice Address - Street 1:430 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-7550
Practice Address - Fax:718-470-4514
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134843207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607736Medicaid
NY00607736Medicaid
NY88079Medicare ID - Type UnspecifiedGHI MEDICARE NUMBER