Provider Demographics
NPI:1619159357
Name:ZG ADVANCED PODIATRY SERVICES, PC
Entity Type:Organization
Organization Name:ZG ADVANCED PODIATRY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-434-8922
Mailing Address - Street 1:820 E 10TH ST APT 6G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2835
Mailing Address - Country:US
Mailing Address - Phone:718-434-8922
Mailing Address - Fax:
Practice Address - Street 1:820 E 10TH ST APT 6G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2835
Practice Address - Country:US
Practice Address - Phone:718-434-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006194213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006194OtherLICENSE