Provider Demographics
NPI:1023409364
Name:ZETOUNE, TAREK SAMIH
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:SAMIH
Last Name:ZETOUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BI COUNTY BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3923
Mailing Address - Country:US
Mailing Address - Phone:631-465-6300
Mailing Address - Fax:
Practice Address - Street 1:110 BI COUNTY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3923
Practice Address - Country:US
Practice Address - Phone:631-465-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2805012080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program