Provider Demographics
NPI:1043385933
Name:ZEGELSTEIN, RICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:ZEGELSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65A BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1616
Mailing Address - Country:US
Mailing Address - Phone:917-822-4074
Mailing Address - Fax:516-487-8155
Practice Address - Street 1:65A BEVERLY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1616
Practice Address - Country:US
Practice Address - Phone:917-822-4074
Practice Address - Fax:516-570-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160215207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23F641Medicare ID - Type Unspecified