Provider Demographics
NPI:1760494355
Name:ZELAYA, JAVIER (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:ZELAYA
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PROSPECT PARK W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5806
Mailing Address - Country:US
Mailing Address - Phone:718-832-3313
Mailing Address - Fax:718-832-2287
Practice Address - Street 1:254 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5806
Practice Address - Country:US
Practice Address - Phone:718-832-3313
Practice Address - Fax:718-832-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04U291Medicare UPIN
NYG18573Medicare ID - Type Unspecified