Provider Demographics
NPI:1659335537
Name:ZONENASHVILI, MERABI (DPM)
Entity Type:Individual
Prefix:
First Name:MERABI
Middle Name:
Last Name:ZONENASHVILI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 BARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3322
Mailing Address - Country:US
Mailing Address - Phone:718-720-6866
Mailing Address - Fax:718-720-6931
Practice Address - Street 1:970 BARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3322
Practice Address - Country:US
Practice Address - Phone:718-720-6866
Practice Address - Fax:718-720-6931
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005659213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049329Medicaid
NYPB615PPX41Medicare PIN
NYU79700Medicare UPIN
NYPB6151Medicare ID - Type Unspecified