Individual
JUSTIN ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1333 ROANOKE AVE, RIVERHEAD, NY 11901
(631) 727-2755
(631) 208-9521
Mailing address
1333 ROANOKE AVE, RIVERHEAD, NY 11901
(631) 727-2755
(631) 208-9521
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
209465
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02206999
—
NY
01
—
CF3402
RR MEDICARE
NY
01
—
W11401
BC/BS
NY
01
—
W22111
MEDICARE GROUP SHR
NY
01
—
WEU091
MEDICARE GROUP HR
NY
Enumeration date
08/28/2006
Last updated
05/16/2008
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