Provider Demographics
NPI:1891057121
Name:ZISKIN, RIVKY MIRIAM
Entity Type:Individual
Prefix:
First Name:RIVKY
Middle Name:MIRIAM
Last Name:ZISKIN
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 1:103 S SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2022
Mailing Address - Country:US
Mailing Address - Phone:917-922-0450
Mailing Address - Fax:
Practice Address - Street 1:103 S SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-2022
Practice Address - Country:US
Practice Address - Phone:917-922-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist