Provider Demographics
NPI:1437697091
Name:PRUSHINOVSKY, ZVI
Entity Type:Individual
Prefix:
First Name:ZVI
Middle Name:
Last Name:PRUSHINOVSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N COLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-4737
Mailing Address - Country:US
Mailing Address - Phone:845-536-8622
Mailing Address - Fax:
Practice Address - Street 1:72 N COLE AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-4737
Practice Address - Country:US
Practice Address - Phone:845-536-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04608513251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04608513Medicaid
NYBF6GMedicaid