1033427141 NPI number — ALEXANDER ZLATNIK MD,PHD,PC

Table of content: (NPI 1033427141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033427141 NPI number — ALEXANDER ZLATNIK MD,PHD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALEXANDER ZLATNIK MD,PHD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033427141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8597 BUSTLETON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19152-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-725-9100
Provider Business Mailing Address Fax Number:
215-725-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8597 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-725-9100
Provider Business Practice Location Address Fax Number:
215-725-9102
Provider Enumeration Date:
09/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ZLATNIK
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
215-725-9100

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD057614L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 433058 . This is a "INDEPENDENCE BLUECROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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