Provider Demographics
NPI:1083640478
Name:ZHITNIKOV, SERGEY (MD)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:ZHITNIKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:POB 11, SUITE 326
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3901
Mailing Address - Country:US
Mailing Address - Phone:610-619-8450
Mailing Address - Fax:610-619-8451
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:ACP 11, SUITE 326
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-619-8450
Practice Address - Fax:610-619-8451
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044063208600000X
PAMD450442208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044063OtherCONNECTICARE
CT2V7418OtherHEALTH NET
CT560H71OtherEMPIRE BC/BS
CT9386052OtherCIGNA
CT1207285OtherAETNA - HMO
CT7370741OtherAETNA - PPO
CT1207285OtherAETNA - HMO
I51884Medicare UPIN
NYA400030960Medicare PIN