Provider Demographics
NPI:1508355645
Name:ZLOTNIK-MAZORI, TATYANA (RPH)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:ZLOTNIK-MAZORI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CRABTREE LN
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2402
Mailing Address - Country:US
Mailing Address - Phone:201-835-3143
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDEWELL PL
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1724
Practice Address - Country:US
Practice Address - Phone:973-779-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02275900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty