Provider Demographics
NPI:1073689246
Name:ZIRKIYEV, DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ZIRKIYEV
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16040 78TH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1945
Mailing Address - Country:US
Mailing Address - Phone:718-544-1444
Mailing Address - Fax:
Practice Address - Street 1:16040 78TH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1945
Practice Address - Country:US
Practice Address - Phone:718-544-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02521337Medicaid
NY05331IMedicare ID - Type UnspecifiedMCR
NY02521337Medicaid