Healthcare Provider Details

I. General information

NPI: 1326384074
Provider Name (Legal Business Name): NEVENKA K ZIC MD, FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14127 COOLIDGE AVE
JAMAICA NY
11435-1120
US

IV. Provider business mailing address

14127 COOLIDGE AVE
JAMAICA NY
11435-1120
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-1705
  • Fax:
Mailing address:
  • Phone: 718-291-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number085463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: