Provider Demographics
NPI:1033427141
Name:ALEXANDER ZLATNIK MD,PHD,PC
Entity Type:Organization
Organization Name:ALEXANDER ZLATNIK MD,PHD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZLATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-725-9100
Mailing Address - Street 1:8597 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1215
Mailing Address - Country:US
Mailing Address - Phone:215-725-9100
Mailing Address - Fax:215-725-9102
Practice Address - Street 1:8597 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1215
Practice Address - Country:US
Practice Address - Phone:215-725-9100
Practice Address - Fax:215-725-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057614L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA433058OtherINDEPENDENCE BLUECROSS
PA901693Medicare PIN
PA433058OtherINDEPENDENCE BLUECROSS