Healthcare Provider Details

I. General information

NPI: 1871101501
Provider Name (Legal Business Name): FALLON VICTORIA ZIELENSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FALLON VICTORIA ETKIN PA-C

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 ROUTE 146 STE 700
CLIFTON PARK NY
12065-3662
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-383-0891
  • Fax: 518-383-1662
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: