Provider Demographics
NPI:1972865152
Name:ZBAR, ELLEN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:ZBAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE
Mailing Address - Street 2:SUITE 2618
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-0110
Mailing Address - Country:US
Mailing Address - Phone:212-868-2507
Mailing Address - Fax:212-868-2510
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:SUITE 2618
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118-0110
Practice Address - Country:US
Practice Address - Phone:212-868-2507
Practice Address - Fax:212-868-2510
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046141122300000X, 1223E0200X, 1223G0001X, 1223P0221X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046141OtherDDS NEW YORK STATE LIC #