Healthcare Provider Details

I. General information

NPI: 1871774307
Provider Name (Legal Business Name): LEV ZAVULUNOV RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S MIDDLE NECK RD
GREAT NECK NY
11021-3455
US

IV. Provider business mailing address

99 NASSAU ST
NEW YORK NY
10038-3455
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-5900
  • Fax: 516-829-5901
Mailing address:
  • Phone: 212-962-4900
  • Fax: 212-962-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: