Provider Demographics
NPI:1477635894
Name:ZHUKOVSKY, LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:ZHUKOVSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 QUENTIN RD
Mailing Address - Street 2:STE M1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1310
Mailing Address - Country:US
Mailing Address - Phone:718-376-3074
Mailing Address - Fax:
Practice Address - Street 1:1812 QUENTIN RD
Practice Address - Street 2:STE M1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1310
Practice Address - Country:US
Practice Address - Phone:718-376-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01426475Medicaid