Healthcare Provider Details

I. General information

NPI: 1770459935
Provider Name (Legal Business Name): ELCHANAN ZLOCZOWER MD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT ST
PHILADELPHIA PA
19107-4216
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6784
  • Fax:
Mailing address:
  • Phone: 215-955-6784
  • Fax: 215-923-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberLT001070
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: