MEDICARE: DR. ZINA SUCHAREVSKI-GOTLIEB DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	047344	NY

General Provider Information

NPI Number	:	1639334477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZINA SUCHAREVSKI-GOTLIEB DDS

Provider Business Mailing Address
First Line	:	6155 98TH ST
Second Line	:	REGO PARK, SUITE 1L
City	:	REGO PARK
State	:	NY
Zip	:	11374-1434
Country	:	US
Telephone Number	:	718-699-8854
Fax Number	:

Provider Business Practice Location Address
First Line	:	6155 98TH ST
Second Line	:	REGO PARK, NEW YORK, SUITE 1L
City	:	REGO PARK
State	:	NY
Zip	:	11374
Country	:	US
Telephone Number	:	718-699-8854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	03/09/2020

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