Provider Demographics
NPI:1639334477
Name:SUCHAREVSKI-GOTLIEB, ZINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZINA
Middle Name:
Last Name:SUCHAREVSKI-GOTLIEB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 98TH ST
Mailing Address - Street 2:REGO PARK, SUITE 1L
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1434
Mailing Address - Country:US
Mailing Address - Phone:718-699-8854
Mailing Address - Fax:
Practice Address - Street 1:6155 98TH ST
Practice Address - Street 2:REGO PARK, NEW YORK, SUITE 1L
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-699-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist