Healthcare Provider Details

I. General information

NPI: 1821258492
Provider Name (Legal Business Name): EILEEN ANN ZHIVAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 09/11/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH AVE W
WESTFIELD NJ
07090-1491
US

IV. Provider business mailing address

215 NORTH AVE W
WESTFIELD NJ
07090-1491
US

V. Phone/Fax

Practice location:
  • Phone: 908-308-4500
  • Fax: 908-308-4515
Mailing address:
  • Phone: 908-308-4500
  • Fax: 908-308-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number273105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: