Healthcare Provider Details

I. General information

NPI: 1588677504
Provider Name (Legal Business Name): MINZALIA ZOUBTSOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ROCKAWAY TPKE SUITE
LAWRENCE NY
11559-1216
US

IV. Provider business mailing address

215 ROCKAWAY TPKE SUITE
LAWRENCE NY
11559-1216
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-5024
  • Fax: 516-374-5816
Mailing address:
  • Phone: 516-374-5024
  • Fax: 516-374-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number241143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: