Provider Demographics
NPI:1447297247
Name:ZODA, DENNIS (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ZODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:ZODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:19 SCHERMERHORN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4802
Mailing Address - Country:US
Mailing Address - Phone:718-237-2495
Mailing Address - Fax:718-228-7116
Practice Address - Street 1:19 SCHERMERHORN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4802
Practice Address - Country:US
Practice Address - Phone:718-237-2495
Practice Address - Fax:718-228-7116
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216808-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02582387Medicaid
NY02582387Medicaid
NYDZ5163B1Medicare PIN
NY02582387Medicaid