Healthcare Provider Details

I. General information

NPI: 1659469260
Provider Name (Legal Business Name): ELLA ZAVOLUNOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 91ST ST SUITE 1J
JACKSON HEIGHTS NY
11372-1749
US

IV. Provider business mailing address

3347 91ST ST SUITE 1J
JACKSON HEIGHTS NY
11372-1749
US

V. Phone/Fax

Practice location:
  • Phone: 718-424-2332
  • Fax: 718-424-2386
Mailing address:
  • Phone: 718-424-2332
  • Fax: 718-424-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number237321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: