Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 025847 | NY |
NPI | 1134509029 |
---|---|
Provider Name | Dr. Tristan Zaide |
First Address | Middle Village, NY 11379-5464 |
Second Address | Middle Village, NY 11379-5464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 04/06/2015 |