Provider Demographics
NPI:1922607688
Name:ZAVULUNOV, IOSIF
Entity Type:Individual
Prefix:
First Name:IOSIF
Middle Name:
Last Name:ZAVULUNOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15922 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3992
Mailing Address - Country:US
Mailing Address - Phone:646-434-2106
Mailing Address - Fax:646-434-2103
Practice Address - Street 1:15922 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3992
Practice Address - Country:US
Practice Address - Phone:646-434-2106
Practice Address - Fax:646-434-2103
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy