Healthcare Provider Details

I. General information

NPI: 1316015340
Provider Name (Legal Business Name): MARK I ZELNICK AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 FLATBUSH AVE
BROOKLYN NY
11234-4516
US

IV. Provider business mailing address

2204 FLATBUSH AVE
BROOKLYN NY
11234-4516
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-0557
  • Fax:
Mailing address:
  • Phone: 718-252-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: