Healthcare Provider Details

I. General information

NPI: 1093951931
Provider Name (Legal Business Name): OLGA ZOLOTNITSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W TABOR RD FL 3
PHILADELPHIA PA
19141-3019
US

IV. Provider business mailing address

101 E OLNEY AVE STE 400
PHILADELPHIA PA
19120-2470
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-3930
  • Fax: 215-456-1432
Mailing address:
  • Phone: 215-456-1825
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA001525L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: