Healthcare Provider Details

I. General information

NPI: 1275148835
Provider Name (Legal Business Name): EDWARD ZAVULUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14743 73RD AVE APT 3H
FLUSHING NY
11367-2946
US

IV. Provider business mailing address

14743 73RD AVE APT 3H
FLUSHING NY
11367-2946
US

V. Phone/Fax

Practice location:
  • Phone: 347-219-1517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number020684
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: