Healthcare Provider Details

I. General information

NPI: 1306392840
Provider Name (Legal Business Name): DAVID ZISHA KINRAICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 15TH AVE APT 4L
BROOKLYN NY
11219-3236
US

IV. Provider business mailing address

1500 TEANECK RD APT 432
TEANECK NJ
07666-3659
US

V. Phone/Fax

Practice location:
  • Phone: 347-268-2220
  • Fax:
Mailing address:
  • Phone: 347-268-2220
  • Fax: 510-991-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number305074
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS18506
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB11226100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: