Basic Information
| Provider Information | |||||||||
| NPI: | 1235512070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAVORY | ||||||||
| FirstName: | MARINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 LINDEN ST | ||||||||
| Address2: | #26 | ||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068511548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038564746 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4 LORRAINE AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105531222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146637070 | ||||||||
| FaxNumber: | 9146637075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 04/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.