Healthcare Provider Details

I. General information

NPI: 1861542540
Provider Name (Legal Business Name): ZELIMIR VUKASIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 JAMAICA AVE
JAMAICA NY
11435-4042
US

IV. Provider business mailing address

85-29 66TH AVE
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone: 718-730-9038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number207937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: