Provider Demographics
NPI:1316244429
Name:ZAGORSKI, M. DAPHNE
Entity type:Individual
Prefix:
First Name:M.
Middle Name:DAPHNE
Last Name:ZAGORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DAPHNE
Other - Last Name:ZAGORSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:109 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1958
Mailing Address - Country:US
Mailing Address - Phone:631-754-7003
Mailing Address - Fax:
Practice Address - Street 1:109 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1958
Practice Address - Country:US
Practice Address - Phone:631-754-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487732-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse