Provider Demographics
NPI:1962438598
Name:ZHURAVENKO, IGOR (MD)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:ZHURAVENKO
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 1:197 BEACH 137 STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-375-1777
Mailing Address - Fax:718-382-1777
Practice Address - Street 1:3048 BRIGHTON 1ST ST # 6B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8080
Practice Address - Country:US
Practice Address - Phone:718-945-4545
Practice Address - Fax:347-702-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01879116Medicaid
NY032AG1Medicare ID - Type Unspecified
NY01879116Medicaid