Provider Demographics
NPI:1275175770
Name:EILEEN A. ZHIVAGO, M.D., LLC
Entity Type:Organization
Organization Name:EILEEN A. ZHIVAGO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHIVAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-248-3186
Mailing Address - Street 1:19 RYERSON PL
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2505
Mailing Address - Country:US
Mailing Address - Phone:646-248-3186
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE W
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1491
Practice Address - Country:US
Practice Address - Phone:908-308-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty