Healthcare Provider Details

I. General information

NPI: 1275582165
Provider Name (Legal Business Name): KISHOR ZINZUVADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KISHOR ZINZUVADIA MD

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 FREEDOM PLAINS RD STE 123
POUGHKEEPSIE NY
12603-2697
US

IV. Provider business mailing address

1 ASH CT
POUGHKEEPSIE NY
12603-3732
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-8743
  • Fax: 845-485-3809
Mailing address:
  • Phone: 845-452-7975
  • Fax: 845-452-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1669881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: