Healthcare Provider Details

I. General information

NPI: 1659637247
Provider Name (Legal Business Name): ZNAHAR MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2012
Last Update Date: 04/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 FOREST AVE
STATEN ISLAND NY
10310-2507
US

IV. Provider business mailing address

682 FOREST AVE
STATEN ISLAND NY
10310-2507
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-0848
  • Fax: 718-698-9412
Mailing address:
  • Phone: 718-816-0848
  • Fax: 718-698-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number60-246539
License Number StateNY

VIII. Authorized Official

Name: DR. KATERYNA PEREVOZNYCHENKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-816-0848