Provider Demographics
NPI:1336575158
Name:DIANA ZABARKO OD LLC
Entity Type:Organization
Organization Name:DIANA ZABARKO OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABARKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-797-2066
Mailing Address - Street 1:286 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2014
Mailing Address - Country:US
Mailing Address - Phone:201-773-8885
Mailing Address - Fax:201-797-2066
Practice Address - Street 1:1690 RATZER RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2436
Practice Address - Country:US
Practice Address - Phone:917-327-3811
Practice Address - Fax:973-904-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00583800261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9131809Medicaid
NJ9131809Medicaid