Healthcare Provider Details

I. General information

NPI: 1104697549
Provider Name (Legal Business Name): ANDREW ZHININ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 MAMARONECK AVE STE 150
WHITE PLAINS NY
10605-5222
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 150
WHITE PLAINS NY
10605-5222
US

V. Phone/Fax

Practice location:
  • Phone: 914-328-2868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: