1578631289 NPI number — DR. ABRAHAM ZLATIN OD

Table of content: DR. ABRAHAM ZLATIN OD (NPI 1578631289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578631289 NPI number — DR. ABRAHAM ZLATIN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZLATIN
Provider First Name:
ABRAHAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1578631289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 WILMOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARSDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-472-5932
Provider Business Mailing Address Fax Number:
914-472-7485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 W 79TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10024-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-724-8855
Provider Business Practice Location Address Fax Number:
212-724-8081
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NYS449 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6795352 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1776453 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5203902 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3031066 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421603008 . This is a "HORIZON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1851925 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6599447 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 516103 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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