Provider Demographics
NPI:1538480546
Name:GINZBURG, YEVGENY
Entity Type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:GINZBURG
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 1:36 HAMILTON AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1820
Mailing Address - Country:US
Mailing Address - Phone:718-207-1874
Mailing Address - Fax:718-448-5668
Practice Address - Street 1:36 HAMILTON AVE APT 4A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1820
Practice Address - Country:US
Practice Address - Phone:718-207-1874
Practice Address - Fax:718-448-5668
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency