Healthcare Provider Details

I. General information

NPI: 1154611184
Provider Name (Legal Business Name): ELISABETH KATHERINE ZUKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 FLATBUSH AVENUE EXT FL 2
BROOKLYN NY
11201-3001
US

IV. Provider business mailing address

4209 28TH ST # CN-48
LONG ISLAND CITY NY
11101-4130
US

V. Phone/Fax

Practice location:
  • Phone: 347-396-6299
  • Fax: 347-396-6367
Mailing address:
  • Phone: 347-396-6299
  • Fax: 347-396-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number284413-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: