Provider Demographics
NPI:1407158017
Name:ZELDIS, ETTI DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ETTI
Middle Name:DEBORAH
Last Name:ZELDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ETTI
Other - Middle Name:DEBORAH
Other - Last Name:ECKSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:235 W 102ND ST
Mailing Address - Street 2:#2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8400
Mailing Address - Country:US
Mailing Address - Phone:862-812-1638
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:NW6 MEDICINE OFFICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-6098
Practice Address - Fax:718-920-8375
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine