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General NPI Number Information
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NPI Number | 1356671671
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Entity Type | Individual
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Provider Name | ELLEN ZHURAVSKY R-PAC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1902 86TH ST
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City | BROOKLYN
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State | NY
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Zip | 11214-3104
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Country | US
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Telephone | 718-621-9400
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Fax | 718-621-9777
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Provider Business Mailing Address
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Address Line | 6309 BAY PKWY APT#B9
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City | BROOKLYN
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State | NY
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Zip | 11204-3255
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Country | US
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Telephone | 718-450-4553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010199
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License Number State | NY
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