JUSTIN ZACK (NPI# 1407964695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407964695 |
| Entity Type | Individual |
| Full Name | JUSTIN ZACK |
| Credential | MD |
| Practice Address |
1333 Roanoke Ave Riverhead NY 11901 |
| Practice Telephone | 6317272755 |
| Practice Fax Number | 6312089521 |
| Mailing Telephone | 6317272755 |
| Mailing Fax Number | 6312089521 |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2008-05-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
209465 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02206999 | 05 | |
| NY | RR MEDICARE | CF3402 | 01 |
| NY | MEDICARE GROUP HR | WEU091 | 01 |
| NY | MEDICARE GROUP SHR | W22111 | 01 |
| NY | BC/BS | W11401 | 01 |
| Street Address |
1333 ROANOKE AVE |
| City | RIVERHEAD |
| State | NY |
| Zip Code | 11901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487619409 | Zeinab Fathelbab | Specialist | 1333 Roanoke Ave, Riverhead, NY 11901-2029 | 2006-04-20 |
| 1467842518 | William F Buffone Dpm | Durable Medical Equipment & Medical Supplies | 1333 Roanoke Ave, Suite 204, Riverhead, NY 11901-2029 | 2015-01-28 |
| 1770841256 | Paul Youn | Internal Medicine | 1333 Roanoke Ave, Riverhead, NY 11901-2029 | 2012-05-02 |
| 1902078173 | Urological Associates of Li, PC | Specialist | 1333 Roanoke Ave, Riverhead, NY 11901-2029 | 2008-03-28 |
| 1942369608 | Martin Vandyne | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901-2029 | 2006-12-08 |
| 1356451157 | William Brancaccio | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901 | 2006-08-30 |
| 1427061126 | Margaret Whelan | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901 | 2006-08-14 |
| 1316950017 | Renu Hausen | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901 | 2006-08-14 |
| 1225041924 | David Kirshy | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901 | 2006-08-14 |
| 1134132830 | David Gross | Radiology | 1333 Roanoke Ave, Riverhead, NY 11901 | 2006-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578102786 | Michael Arthur Frangeskos | Physician Assistant | 1330 Roanoke Avenue, Riverhead, NY 11901 | 2020-01-06 |
| 1922569136 | Mjd Optical Corp | Optometrist | 1053 Route 58 Roanoke Ave, Riverhead, NY 11901 | 2019-03-29 |
| 1356837702 | Justin M Liu | Physician Assistant | 31 Main Rd Ste 3, Riverhead, NY 11901 | 2018-07-09 |
| 1467943522 | North Shore Hematology Oncology Associates PC | Clinic/Center | 750 Old Country Rd Bldg 2, Riverhead, NY 11901 | 2018-05-24 |
| 1063918688 | Riverhead Volunteer Ambulance Corps Inc | Ambulance | 111 Osborn Ave, Riverhead, NY 11901 | 2018-04-03 |
| 1669977906 | Joseph Cataldo | Student in an Organized Health Care Education/Training Program | 64 Ida Lane, Riverhead, NY 11901 | 2018-03-28 |
| 1861903056 | The Flanders Northampton Volunteer Ambulance Company Inc | Ambulance | 641 Flanders Road, Flanders, NY 11901 | 2017-10-16 |
| 1336676659 | Patricia Ann Leask | Registered Nurse | 300 Center Drive Suite 250, Methadone Clinic Department of Mental Health, Riverhead, NY 11901 | 2017-05-17 |
| 1922463447 | Diana Williams-burke | Counselor | 550 East Main St Suite 103, Riverhead, NY 11901 | 2015-12-29 |
| 1699155549 | Twin Forks Optometry, Pllc | Optometrist | 25 Cranberry Street, Riverhead, NY 11901 | 2015-06-05 |
| Find all providers in zip 11901 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
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| 1962917492 | Israel Schur Md Pllc | Radiology | 202 Centre St Fl 5, New York, NY 10013-3613 | 2017-12-06 |
| 1659897775 | 9909 Medical | Radiology | 2515 Crescent St Ste 1, Astoria, NY 11102-4370 | 2017-08-21 |
| 1104357896 | Paramount Diagnostics LLC | Radiology | 201 Irving Pl, Woodmere, NY 11598-1639 | 2017-03-23 |
| 1881009926 | Dennis Cummings | Radiology | 450 Clarkson Ave., Box 1262, Department Suny Downstate Medical Center, Brooklyn, NY 11203-1262 | 2014-06-27 |
| 1699192815 | Amir Noor | Radiology | 240 E 86th St Apt Phb, New York, NY 10028-3000 | 2014-03-26 |
| 1689014987 | Advanced Access Medical Care, Pllc | Radiology | 1733 Eastchester Rd, Bronx, NY 10461-2315 | 2013-07-01 |
| 1851739601 | Vascular Interventional Services | Radiology | 6335 Transit Rd, Depew, NY 14043-1030 | 2013-06-13 |
| 1437406238 | Arbabzadeh Massoud Physician, PC | Radiology | 2809 Wehrle Dr Ste 13, Williamsville, NY 14221-7385 | 2012-08-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.