Healthcare Provider Details

I. General information

NPI: 1235266933
Provider Name (Legal Business Name): MICHAL ZIDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 4TH AVE
NEW YORK NY
10003-4901
US

IV. Provider business mailing address

1 GUSTAVE L. LEVY PLACE BOX 1194
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 201-830-3122
  • Fax: 201-200-0838
Mailing address:
  • Phone: 212-241-8395
  • Fax: 212-289-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number239776
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: