Provider Demographics
NPI:1750994059
Name:PASCHALL-ZIMBEL, MAX ARTHUR (OD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:ARTHUR
Last Name:PASCHALL-ZIMBEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1702
Mailing Address - Country:US
Mailing Address - Phone:718-784-2580
Mailing Address - Fax:
Practice Address - Street 1:4504 46TH ST
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1702
Practice Address - Country:US
Practice Address - Phone:718-784-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTVP009173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist