Provider Demographics
NPI:1508846726
Name:SHIFERAW-DERIBE, ZEWGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEWGE
Middle Name:
Last Name:SHIFERAW-DERIBE
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 1:1710 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4824
Mailing Address - Country:US
Mailing Address - Phone:718-531-2702
Mailing Address - Fax:718-531-2602
Practice Address - Street 1:1710 ROCKAWAY PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:718-467-1545
Practice Address - Fax:718-467-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231792207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364221Medicaid
NY02364221Medicaid
NY7V3501Medicare PIN