Provider Demographics
NPI:1740262310
Name:ZIGELMAN, AVIVA
Entity type:Individual
Prefix:MS
First Name:AVIVA
Middle Name:
Last Name:ZIGELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 NORTHERN BLVD
Mailing Address - Street 2:STE 12
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4804
Mailing Address - Country:US
Mailing Address - Phone:516-625-1617
Mailing Address - Fax:718-423-9705
Practice Address - Street 1:445 NORTHERN BLVD
Practice Address - Street 2:STE 12
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4804
Practice Address - Country:US
Practice Address - Phone:516-625-1617
Practice Address - Fax:718-423-9705
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0191571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker