Healthcare Provider Details

I. General information

NPI: 1578638623
Provider Name (Legal Business Name): MAYA ZHUKOVSKY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 3RD AVE BAY RIDGE FAMILY HEALTH CENTER
BROOKLYN NY
11209-7702
US

IV. Provider business mailing address

5800 3RD AVE MANAGED CARE DEPARTMENT
BROOKLYN NY
11220-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-759-9126
  • Fax:
Mailing address:
  • Phone: 718-630-7477
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number478429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: