Healthcare Provider Details

I. General information

NPI: 1528748100
Provider Name (Legal Business Name): ALEKSANDR ZAVELYUK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 KINGS HWY
BROOKLYN NY
11223-2338
US

IV. Provider business mailing address

936 KINGS HWY
BROOKLYN NY
11223-2338
US

V. Phone/Fax

Practice location:
  • Phone: 917-933-4077
  • Fax: 718-933-4078
Mailing address:
  • Phone: 917-933-4077
  • Fax: 718-933-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: