Provider Demographics
NPI:1306091830
Name:ZAPATA, JESSENIA IVELISSE (MSED)
Entity type:Individual
Prefix:MRS
First Name:JESSENIA
Middle Name:IVELISSE
Last Name:ZAPATA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1022
Mailing Address - Country:US
Mailing Address - Phone:516-424-2215
Mailing Address - Fax:
Practice Address - Street 1:9052 BORKEL PL
Practice Address - Street 2:1ST FLOOR
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1319
Practice Address - Country:US
Practice Address - Phone:516-424-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency