Healthcare Provider Details

I. General information

NPI: 1528804663
Provider Name (Legal Business Name): MS. MICHELLE C ZHIVOTOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11655 QUEENS BLVD STE 216
FOREST HILLS NY
11375-6527
US

IV. Provider business mailing address

64 BAY 46TH ST FL 3
BROOKLYN NY
11214-5516
US

V. Phone/Fax

Practice location:
  • Phone: 212-804-7659
  • Fax:
Mailing address:
  • Phone: 917-834-4947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2734644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: