Provider Demographics
NPI:1164619854
Name:ZILKHA, PHYLLIS S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:S
Last Name:ZILKHA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 79TH ST
Mailing Address - Street 2:23A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0951
Mailing Address - Country:US
Mailing Address - Phone:212-988-7170
Mailing Address - Fax:212-988-7170
Practice Address - Street 1:301 E 79TH ST
Practice Address - Street 2:23A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0951
Practice Address - Country:US
Practice Address - Phone:212-988-7170
Practice Address - Fax:212-988-7170
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011742103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8C461Medicare PIN
NY02874Medicare PIN