Healthcare Provider Details

I. General information

NPI: 1093780538
Provider Name (Legal Business Name): ANNA ZHIVOTOVSKY II MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 YORK AVE
NEW YORK NY
10028-6001
US

IV. Provider business mailing address

14 WALL ST FL 9
NEW YORK NY
10005-2178
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-3329
  • Fax: 212-585-3717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: