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General NPI Number Information
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NPI Number | 1699706861
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Entity Type | Organization
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Legal Business Name | DOC Z FAMILY PRACTICE PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 54 BEDFORD ST
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City | COHOES
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State | NY
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Zip | 12047-2935
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Country | US
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Telephone | 518-237-3629
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Fax | 518-874-2121
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Provider Business Mailing Address
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Address Line | 54 BEDFORD ST
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City | COHOES
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State | NY
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Zip | 12047-2935
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Country | US
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Telephone | 518-237-3629
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Fax | 518-874-2121
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. RUSSELL M ZIVKOVICH
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Credential | M.D.
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Telephone | 518-237-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007941
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License Number State | NY
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