Healthcare Provider Details

I. General information

NPI: 1033451638
Provider Name (Legal Business Name): AVIVA ZIPKIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 KERMIT PL
BROOKLYN NY
11218-1840
US

IV. Provider business mailing address

74 KERMIT PL
BROOKLYN NY
11218-1840
US

V. Phone/Fax

Practice location:
  • Phone: 347-225-7649
  • Fax:
Mailing address:
  • Phone: 347-225-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number667337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: