Provider Demographics
NPI:1427464833
Name:ZAK MEDICAL GROUP PA
Entity type:Organization
Organization Name:ZAK MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-547-3714
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-1048
Mailing Address - Country:US
Mailing Address - Phone:516-547-3714
Mailing Address - Fax:
Practice Address - Street 1:150 PINE FOREST DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:516-547-3714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty