Provider Demographics
NPI:1770152654
Name:MOURABET, ZENA (DDS)
Entity type:Individual
Prefix:
First Name:ZENA
Middle Name:
Last Name:MOURABET
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 1:8 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PART JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-928-8585
Mailing Address - Fax:631-509-0334
Practice Address - Street 1:8 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:PART JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-8585
Practice Address - Fax:631-509-0334
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0632481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07733599Medicaid