Provider Demographics
NPI:1235120114
Name:ZELIKOVSKY, GERALD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ZELIKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0407
Mailing Address - Country:US
Mailing Address - Phone:212-744-0700
Mailing Address - Fax:212-744-8619
Practice Address - Street 1:5 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0407
Practice Address - Country:US
Practice Address - Phone:212-744-0700
Practice Address - Fax:212-744-8619
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105034208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00183197Medicaid
B20010Medicare UPIN
908721Medicare PIN