Provider Demographics
NPI:1164457628
Name:ZEITLIN, ALAN P (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:P
Last Name:ZEITLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:69-60 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4323
Mailing Address - Country:US
Mailing Address - Phone:718-544-0442
Mailing Address - Fax:718-793-4250
Practice Address - Street 1:69-60 108TH STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4323
Practice Address - Country:US
Practice Address - Phone:718-544-0442
Practice Address - Fax:718-793-4250
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1256982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00500647Medicaid
NY00500647Medicaid
NY04560JMedicare ID - Type Unspecified