Provider Demographics
NPI:1205973237
Name:ZEBALLOS, CAROLINA INES (MS)
Entity type:Individual
Prefix:MISS
First Name:CAROLINA
Middle Name:INES
Last Name:ZEBALLOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RICHMOND BLVD UNIT 4B
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3692
Mailing Address - Country:US
Mailing Address - Phone:631-721-3458
Mailing Address - Fax:631-676-4388
Practice Address - Street 1:46 RICHMOND BLVD UNIT 4B
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3692
Practice Address - Country:US
Practice Address - Phone:631-721-3458
Practice Address - Fax:631-676-4388
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator