Provider Demographics
NPI:1689473423
Name:ZACHAROVICH, AMBER (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ZACHAROVICH
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14104 77TH AVE APT F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2805
Mailing Address - Country:US
Mailing Address - Phone:832-863-6521
Mailing Address - Fax:
Practice Address - Street 1:46 COOK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4004
Practice Address - Country:US
Practice Address - Phone:718-701-7300
Practice Address - Fax:718-701-7301
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009109-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant