Provider Demographics
NPI:1679856884
Name:KOYENOV, ZALMAN
Entity type:Individual
Prefix:MR
First Name:ZALMAN
Middle Name:
Last Name:KOYENOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13742 GUY R BREWER BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3733
Mailing Address - Country:US
Mailing Address - Phone:718-978-0001
Mailing Address - Fax:718-978-0003
Practice Address - Street 1:13742 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3732
Practice Address - Country:US
Practice Address - Phone:718-978-0001
Practice Address - Fax:718-978-0003
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047459OtherLICENSE