Healthcare Provider Details

I. General information

NPI: 1578631289
Provider Name (Legal Business Name): ABRAHAM ZLATIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W 79TH ST
NEW YORK NY
10024-6241
US

IV. Provider business mailing address

1098 WILMOT RD
SCARSDALE NY
10583-6863
US

V. Phone/Fax

Practice location:
  • Phone: 212-724-8855
  • Fax: 212-724-8081
Mailing address:
  • Phone: 914-472-5932
  • Fax: 914-472-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNYS449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: