Provider Demographics
NPI:1164480844
Name:GOLDVEKHT, ZINA (PA)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:
Last Name:GOLDVEKHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 YELLOWSTONE BLVD
Mailing Address - Street 2:CFU 101
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1530
Mailing Address - Country:US
Mailing Address - Phone:718-896-3376
Mailing Address - Fax:718-795-1005
Practice Address - Street 1:6405 YELLOWSTONE BLVD
Practice Address - Street 2:CFU 101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1530
Practice Address - Country:US
Practice Address - Phone:718-896-3376
Practice Address - Fax:718-795-1005
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q64819Medicare UPIN
6151L23051Medicare ID - Type Unspecified