Provider Demographics
NPI:1679664171
Name:VERNIKOVA, ZOYA (MD)
Entity Type:Individual
Prefix:
First Name:ZOYA
Middle Name:
Last Name:VERNIKOVA
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 1:365 MAYFAIR DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6930
Mailing Address - Country:US
Mailing Address - Phone:917-680-1150
Mailing Address - Fax:
Practice Address - Street 1:2424 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1669
Practice Address - Country:US
Practice Address - Phone:718-338-9660
Practice Address - Fax:718-338-6559
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668148Medicaid
NY13N12Medicare ID - Type Unspecified
NYG31180Medicare UPIN