Provider Demographics
NPI:1043389539
Name:ZAKHAROV, IGOR (DO)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:ZAKHAROV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 OCEAN AVE
Mailing Address - Street 2:FL 7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4708
Mailing Address - Country:US
Mailing Address - Phone:347-492-6732
Mailing Address - Fax:347-492-6735
Practice Address - Street 1:2748 OCEAN AVE
Practice Address - Street 2:FL 7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4708
Practice Address - Country:US
Practice Address - Phone:347-492-6732
Practice Address - Fax:347-492-6735
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00481Medicare UPIN