Provider Demographics
NPI:1548284961
Name:ZAYDFUDIM, GALENE (FNP)
Entity type:Individual
Prefix:
First Name:GALENE
Middle Name:
Last Name:ZAYDFUDIM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 FAIRFIELD AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3318
Mailing Address - Country:US
Mailing Address - Phone:718-884-1783
Mailing Address - Fax:718-543-6185
Practice Address - Street 1:177 LIVINGSTON STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5875
Practice Address - Country:US
Practice Address - Phone:718-855-7707
Practice Address - Fax:718-855-7717
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334086-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1302G1Medicare UPIN