Provider Demographics
NPI:1306017074
Name:ZLOTNICK, PHYLLIS H (MA, CCC)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:H
Last Name:ZLOTNICK
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 PROSPECT AVE
Mailing Address - Street 2:ENT
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2570
Mailing Address - Country:US
Mailing Address - Phone:201-883-1062
Mailing Address - Fax:
Practice Address - Street 1:385 PROSPECT AVE
Practice Address - Street 2:ENT
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2570
Practice Address - Country:US
Practice Address - Phone:201-883-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00055600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ127542NEWMedicare PIN