Provider Demographics
NPI:1275582165
Name:ZINZUVADIA, KISHOR (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHOR
Middle Name:
Last Name:ZINZUVADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KISHOR
Other - Middle Name:
Other - Last Name:ZINZUVADIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 ASH CT
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3732
Mailing Address - Country:US
Mailing Address - Phone:845-452-7975
Mailing Address - Fax:845-452-2751
Practice Address - Street 1:488 FREEDOM PLAINS RD
Practice Address - Street 2:STE 123
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2697
Practice Address - Country:US
Practice Address - Phone:845-483-8743
Practice Address - Fax:845-485-3809
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16698812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00972349Medicaid
NYA64153Medicare UPIN
NY75D611Medicare PIN
75D611Medicare PIN