Provider Demographics
NPI:1487461638
Name:DECKER, ZACHARY R (CRPA-P)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:R
Last Name:DECKER
Suffix:
Gender:M
Credentials:CRPA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4442 ARTHUR KILL RD STE 4
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1321
Mailing Address - Country:US
Mailing Address - Phone:646-508-7565
Mailing Address - Fax:
Practice Address - Street 1:4442 ARTHUR KILL RD STE 4
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1321
Practice Address - Country:US
Practice Address - Phone:646-508-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7778175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist