Organization
77TH ST-5TH AVE MEDICAL, P.C.
Active
Organization
77TH ST-5TH AVE MEDICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIOT H ZIMBALIST M.D. (OWNER)
(718) 921-5548
Entity
Organization
Contact information
Practice address
452 77TH ST, BROOKLYN, NY 11209-3256
(718) 921-5548
(718) 921-5781
Mailing address
PO BOX 86, JERICHO, NY 11753-0086
(516) 697-6813
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
149213
NY
Other
Enumeration date
03/06/2009
Last updated
07/07/2021
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