Healthcare Provider Details

I. General information

NPI: 1972527646
Provider Name (Legal Business Name): KEITH F ZEITLIN N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT BUILDING 2, SUITE 3B
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

850 N MAIN STREET EXT BUILDING 2, SUITE 3B
WALLINGFORD CT
06492-2400
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-1119
  • Fax: 203-284-1050
Mailing address:
  • Phone: 203-284-1119
  • Fax: 203-284-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000224
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1030
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: