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General NPI Number Information
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NPI Number | 1275175770
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Entity Type | Organization
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Legal Business Name | EILEEN A. ZHIVAGO, M.D., LLC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 215 NORTH AVE W
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City | WESTFIELD
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State | NJ
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Zip | 07090-1491
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Country | US
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Telephone | 908-308-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 19 RYERSON PL
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City | CLOSTER
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State | NJ
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Zip | 07624-2505
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Country | US
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Telephone | 646-248-3186
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. EILEEN ZHIVAGO
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Credential | MD
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Telephone | 646-248-3186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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