Provider Demographics
NPI:1629111646
Name:OCEAN AVENUE PODIATRY PC
Entity Type:Organization
Organization Name:OCEAN AVENUE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERABI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZONENASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-332-3003
Mailing Address - Street 1:2962 OCEAN AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3202
Mailing Address - Country:US
Mailing Address - Phone:718-332-3003
Mailing Address - Fax:718-332-3113
Practice Address - Street 1:2962 OCEAN AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3202
Practice Address - Country:US
Practice Address - Phone:718-332-3003
Practice Address - Fax:718-332-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005659213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049329Medicaid
NYU79700Medicare UPIN
NY02049329Medicaid