Provider Demographics
NPI:1588677504
Name:ZOUBTSOVA, MINZALIA (MD)
Entity Type:Individual
Prefix:
First Name:MINZALIA
Middle Name:
Last Name:ZOUBTSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ROCKAWAY TPKE
Mailing Address - Street 2:SUITE
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1216
Mailing Address - Country:US
Mailing Address - Phone:516-374-5024
Mailing Address - Fax:516-374-5816
Practice Address - Street 1:215 ROCKAWAY TPKE
Practice Address - Street 2:SUITE
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1216
Practice Address - Country:US
Practice Address - Phone:516-374-5024
Practice Address - Fax:516-374-5816
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793737Medicaid
NY0258GJMedicare ID - Type UnspecifiedGHI
NY01793737Medicaid