MEDICARE: MR. EDWARD JAY ZELNICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	26609	FL

General Provider Information

NPI Number	:	1205276854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD JAY ZELNICK M.D.

Provider Business Mailing Address
First Line	:	3620 N 52ND AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2248
Country	:	US
Telephone Number	:	954-849-3640
Fax Number	:	954-962-1528

Provider Business Practice Location Address
First Line	:	3620 N 52ND AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2248
Country	:	US
Telephone Number	:	954-849-3640
Fax Number	:	954-962-1528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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