Provider Demographics
NPI:1588710925
Name:JELVEH, ZIBA (MD)
Entity type:Individual
Prefix:
First Name:ZIBA
Middle Name:
Last Name:JELVEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7724
Mailing Address - Country:US
Mailing Address - Phone:631-470-1384
Mailing Address - Fax:
Practice Address - Street 1:575 UNDERHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3426
Practice Address - Country:US
Practice Address - Phone:516-677-3877
Practice Address - Fax:516-677-8103
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129383207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology