Healthcare Provider Details

I. General information

NPI: 1871842997
Provider Name (Legal Business Name): GERALD ZELIKOVSKY, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 84TH STREET
NEW YORK NY
10002-0407
US

IV. Provider business mailing address

5 EAST 84TH STREET
NEW YORK NY
10002-0407
US

V. Phone/Fax

Practice location:
  • Phone: 212-744-0700
  • Fax: 212-744-8619
Mailing address:
  • Phone: 212-744-0700
  • Fax: 212-744-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number105034
License Number StateNY

VIII. Authorized Official

Name: DR. GERALD ZELIKOVSKY
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 212-744-0700