Provider Demographics
NPI:1811271208
Name:ZHANNA KANEVSKY, MD PC
Entity type:Organization
Organization Name:ZHANNA KANEVSKY, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:ZHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-424-0080
Mailing Address - Street 1:23 BRANFORD PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2711
Mailing Address - Country:US
Mailing Address - Phone:973-424-0080
Mailing Address - Fax:973-424-0088
Practice Address - Street 1:23 BRANFORD PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2711
Practice Address - Country:US
Practice Address - Phone:973-424-0080
Practice Address - Fax:973-424-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07783800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0049441Medicaid
NJ0049441Medicaid
NJG54601Medicare UPIN