Healthcare Provider Details

I. General information

NPI: 1821426156
Provider Name (Legal Business Name): REBECCA ZOLOTKOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LOVELL AVE
STATEN ISLAND NY
10314-4967
US

IV. Provider business mailing address

175 E MAIN ST
RAMSEY NJ
07446-7000
US

V. Phone/Fax

Practice location:
  • Phone: 347-387-2997
  • Fax:
Mailing address:
  • Phone: 347-387-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00675500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: