Provider Demographics
NPI:1407807472
Name:ASFAW, ZERGABACHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:ZERGABACHEW
Middle Name:
Last Name:ASFAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2118
Mailing Address - Country:US
Mailing Address - Phone:718-548-1569
Mailing Address - Fax:718-548-2480
Practice Address - Street 1:3965 SEDGWICK AVE
Practice Address - Street 2:1F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3111
Practice Address - Country:US
Practice Address - Phone:718-548-1569
Practice Address - Fax:718-548-2480
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205328207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24N091Medicare ID - Type Unspecified