Provider Demographics
NPI:1659469260
Name:ZAVOLUNOVA, ELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:ZAVOLUNOVA
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 1:3347 91ST ST
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1749
Mailing Address - Country:US
Mailing Address - Phone:718-424-2332
Mailing Address - Fax:718-424-2386
Practice Address - Street 1:3347 91ST ST
Practice Address - Street 2:SUITE 1J
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1749
Practice Address - Country:US
Practice Address - Phone:718-424-2332
Practice Address - Fax:718-424-2386
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2373212080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYI48877Medicare UPIN
NY00330231Medicare ID - Type Unspecified