Healthcare Provider Details

I. General information

NPI: 1881034874
Provider Name (Legal Business Name): ALLA ZLOTINA OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 ELTINGVILLE BLVD
STATEN ISLAND NY
10312-2447
US

IV. Provider business mailing address

273 ELTINGVILLE BLVD
STATEN ISLAND NY
10312-2447
US

V. Phone/Fax

Practice location:
  • Phone: 917-554-1765
  • Fax:
Mailing address:
  • Phone: 917-554-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006703
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number006703
License Number StateNY

VIII. Authorized Official

Name: ALLA ZLOTINA
Title or Position: PRESIDENT
Credential: OD
Phone: 917-554-1765