Provider Demographics
NPI:1588000665
Name:PHILLIBERT, ZEENIA IRANI (MD)
Entity Type:Individual
Prefix:
First Name:ZEENIA
Middle Name:IRANI
Last Name:PHILLIBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZEENIA
Other - Middle Name:
Other - Last Name:IRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1510 LEXINGTON AVE APT 15C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7168
Mailing Address - Country:US
Mailing Address - Phone:818-802-1533
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT614082085R0202X
NY2978622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1588000665Medicaid