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General NPI Number Information
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NPI Number | 1740673151
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Entity Type | Individual
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Provider Name | PAUL ZHIVAGO DDS
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Gender | Male
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 04/18/2015
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Provider Practice Location Address
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Address Line | 44 E 67TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-6135
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Country | US
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Telephone | 212-988-2955
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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 | 646-318-0510
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 057240-1
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License Number State | NY
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