Provider Demographics
NPI:1699059022
Name:MARINA ZABEZHANSKAYA MD., PC.
Entity type:Organization
Organization Name:MARINA ZABEZHANSKAYA MD., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABEZHANSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-332-6080
Mailing Address - Street 1:2511 OCEAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3950
Mailing Address - Country:US
Mailing Address - Phone:718-332-6080
Mailing Address - Fax:718-332-7570
Practice Address - Street 1:2511 OCEAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3950
Practice Address - Country:US
Practice Address - Phone:718-332-6080
Practice Address - Fax:718-332-7570
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
NY180704261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01580941Medicaid
NYMZ029K8620Medicare PIN