Provider Demographics
NPI:1194760876
Name:HASKAL, ZIV J (MD)
Entity type:Individual
Prefix:
First Name:ZIV
Middle Name:J
Last Name:HASKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEE ST FL 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-9401
Practice Address - Fax:434-982-0887
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD680162085R0204X, 2085R0202X
VA01012547372085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02186203OtherMEDICAID GROUP #
NY8691908OtherMEDICAID GROUP#
NYW34991OtherMEDICARE GROUP#
NYW35021OtherMEDICARE GROUP #
NY02000939Medicaid
NY02186203OtherMEDICAID GROUP #
NYE95783Medicare UPIN