Healthcare Provider Details

I. General information

NPI: 1720043383
Provider Name (Legal Business Name): JITKA LUDMILA ZOBAL-RATNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 ALBANY SHAKER RD SUITE 101
LATHAM NY
12110
US

IV. Provider business mailing address

523 COVINGTON PL
SLINGERLANDS NY
12159-9517
US

V. Phone/Fax

Practice location:
  • Phone: 518-533-6502
  • Fax: 518-533-6505
Mailing address:
  • Phone: 518-533-6502
  • Fax: 518-533-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number186248
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number186248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: