=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629111646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN AVENUE PODIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2962 OCEAN AVE UNIT 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-332-3003
-----------------------------------------------------
Fax | 718-332-3113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2962 OCEAN AVE UNIT 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-3202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-332-3003
-----------------------------------------------------
Fax | 718-332-3113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MERABI ZONENASHVILI
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 718-332-3003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | N005659
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------