=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922129014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 03/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 GRANDVIEW AVE LOWER LEVEL SUITE 4
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-755-4515
-----------------------------------------------------
Fax | 203-755-8129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 GRANDVIEW AVE LOWER LEVEL SUITE 4
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-755-4515
-----------------------------------------------------
Fax | 203-755-8129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RONALD A ZLOTOFF
-----------------------------------------------------
Credential | M.D., F.A.C.P.
-----------------------------------------------------
Telephone | 203-755-4515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------