Basic Information
Provider Information
NPI: 1639792799
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZULUETA
FirstName: JAVIER
MiddleName: JOSEPH
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058186
FaxNumber:  
Practice Location
Address1: 1111 AMSTERDAM AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100251716
CountryCode: US
TelephoneNumber: 2125234000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/24/2020
LastUpdateDate: 11/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X304315NYY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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