Provider Demographics
NPI:1104805605
Name:ZAGON, ROY LEWIS (DPM)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:LEWIS
Last Name:ZAGON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PLANDOME ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-365-5544
Mailing Address - Fax:516-365-5545
Practice Address - Street 1:535 PLANDOME ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-365-5544
Practice Address - Fax:516-365-5545
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T50963Medicare UPIN
NYP33353Medicare ID - Type Unspecified