Provider Demographics
NPI:1376503664
Name:GONDAL, ZOHA FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:ZOHA
Middle Name:FATIMA
Last Name:GONDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZOHA
Other - Middle Name:FATIMA
Other - Last Name:RASOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:#314
Mailing Address - City:ROCKVILLE CTR
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-678-6868
Mailing Address - Fax:516-678-6997
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:#314
Practice Address - City:ROCKVILLE CTR
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-678-6868
Practice Address - Fax:516-678-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200154207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817909Medicaid
NY806781Medicare ID - Type Unspecified
NY01817909Medicaid