Provider Demographics
NPI:1528804663
Name:ZHIVOTOVSKY, MICHELLE C
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:C
Last Name:ZHIVOTOVSKY
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 1:64 BAY 46TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5516
Mailing Address - Country:US
Mailing Address - Phone:917-834-4947
Mailing Address - Fax:
Practice Address - Street 1:11655 QUEENS BLVD STE 216
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6527
Practice Address - Country:US
Practice Address - Phone:212-804-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2734644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty