Healthcare Provider Details

I. General information

NPI: 1568715589
Provider Name (Legal Business Name): NATAN ZAVLYANOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 AUSTIN ST SUITE 200
FOREST HILLS NY
11375-1022
US

IV. Provider business mailing address

9841 QUEENS BLVD 2E
REGO PARK NY
11374-4361
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7633
  • Fax: 718-886-8694
Mailing address:
  • Phone: 718-962-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: