Provider Demographics
NPI:1154486082
Name:ZELLAN, JONATHAN D (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:ZELLAN
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 1:803 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3903
Mailing Address - Country:US
Mailing Address - Phone:718-613-1700
Mailing Address - Fax:718-735-6382
Practice Address - Street 1:803 STERLING PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3903
Practice Address - Country:US
Practice Address - Phone:718-613-1700
Practice Address - Fax:718-735-6382
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215793207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591055Medicaid
NYPENDINGMedicare ID - Type Unspecified
NY02591055Medicaid