Healthcare Provider Details

I. General information

NPI: 1235451287
Provider Name (Legal Business Name): ELLEN ZLOBINSKIY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FORT WASHINGTON AVE SUITE 1A
NEW YORK NY
10033-6849
US

IV. Provider business mailing address

400 FORT WASHINGTON AVE SUITE 1A
NEW YORK NY
10033-6849
US

V. Phone/Fax

Practice location:
  • Phone: 212-795-9500
  • Fax: 212-795-9501
Mailing address:
  • Phone: 212-795-9500
  • Fax: 212-795-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF335668-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: