Provider Demographics
NPI:1376174847
Name:FANCHIKI, ZITA
Entity Type:Individual
Prefix:
First Name:ZITA
Middle Name:
Last Name:FANCHIKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1237
Mailing Address - Country:US
Mailing Address - Phone:551-232-8919
Mailing Address - Fax:
Practice Address - Street 1:60 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1237
Practice Address - Country:US
Practice Address - Phone:551-232-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY759393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse