1922129014 NPI number — RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC

Table of content: (NPI 1922129014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922129014 NPI number — RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC
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:
1922129014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 GRANDVIEW AVE
Provider Second Line Business Mailing Address:
LOWER LEVEL SUITE 4
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-755-4515
Provider Business Mailing Address Fax Number:
203-755-8129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL SUITE 4
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-755-4515
Provider Business Practice Location Address Fax Number:
203-755-8129
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZLOTOFF
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-755-4515

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010020649CT03 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001206499 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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