Provider Demographics
NPI:1508898792
Name:ZLOTNICK, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:ZLOTNICK
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 1:1474 TANYARD ROAD, SUITE C100
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3096
Mailing Address - Country:US
Mailing Address - Phone:855-932-7476
Mailing Address - Fax:856-566-6384
Practice Address - Street 1:1474 TANYARD ROAD, SUITE C100
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3096
Practice Address - Country:US
Practice Address - Phone:855-932-7476
Practice Address - Fax:856-566-6384
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426521207Q00000X, 207QS0010X
NJ25MA04613800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1214900Medicaid
NJ1214900Medicaid
NJ166573ZPCNMedicare PIN
PA114617YUNMMedicare PIN
NJ1214900Medicaid