Provider Demographics
NPI:1972808236
Name:WOLINSKY-ZAZON, MIA
Entity type:Individual
Prefix:MISS
First Name:MIA
Middle Name:
Last Name:WOLINSKY-ZAZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BESEN PKWY
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3510
Mailing Address - Country:US
Mailing Address - Phone:914-393-6434
Mailing Address - Fax:
Practice Address - Street 1:31 BESEN PKWY
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3510
Practice Address - Country:US
Practice Address - Phone:914-393-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY989931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered