Provider Demographics
NPI:1356671671
Name:ZHURAVSKY, ELLEN (R-PAC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ZHURAVSKY
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 BAY PKWY
Mailing Address - Street 2:APT#B9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3255
Mailing Address - Country:US
Mailing Address - Phone:718-450-4553
Mailing Address - Fax:
Practice Address - Street 1:1902 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3104
Practice Address - Country:US
Practice Address - Phone:718-621-9400
Practice Address - Fax:718-621-9777
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant