Healthcare Provider Details

I. General information

NPI: 1255308920
Provider Name (Legal Business Name): ELLYN R ZITZER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

19 BROWN AVE
ROSLINDALE MA
02131-3623
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6487
  • Fax: 617-730-0337
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number238
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: