Provider Demographics
NPI:1942210380
Name:ZELIKSON, IRINA YELYANOVNA (DO)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:YELYANOVNA
Last Name:ZELIKSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CATHERINE CT
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HBR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2907
Mailing Address - Country:US
Mailing Address - Phone:732-441-3772
Mailing Address - Fax:
Practice Address - Street 1:57 BRANT AVE
Practice Address - Street 2:STE.102
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1568
Practice Address - Country:US
Practice Address - Phone:732-340-1006
Practice Address - Fax:732-340-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB 073201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine