Healthcare Provider Details

I. General information

NPI: 1316285695
Provider Name (Legal Business Name): IVKA ZIC R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 UNDERHILL RD
OSSINING NY
10562-5103
US

IV. Provider business mailing address

61 UNDERHILL RD
OSSINING NY
10562-5103
US

V. Phone/Fax

Practice location:
  • Phone: 914-433-1117
  • Fax:
Mailing address:
  • Phone: 914-433-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number301827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: