Healthcare Provider Details

I. General information

NPI: 1992077929
Provider Name (Legal Business Name): OLENA ZINSHTEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W WASHINGTON SQ STE 120
PHILADELPHIA PA
19106-3581
US

IV. Provider business mailing address

704 SANSOM ST SUITE 202
PHILADELPHIA PA
19106-3231
US

V. Phone/Fax

Practice location:
  • Phone: 215-305-8860
  • Fax: 215-305-8862
Mailing address:
  • Phone: 215-305-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004321
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: