Healthcare Provider Details

I. General information

NPI: 1073689246
Provider Name (Legal Business Name): DAVID ZIRKIYEV PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16040 78TH RD SUITE 200
FRESH MEADOWS NY
11366-1945
US

IV. Provider business mailing address

16040 78TH RD SUITE 200
FRESH MEADOWS NY
11366-1945
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-1444
  • Fax:
Mailing address:
  • Phone: 718-544-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0065821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: