Provider Demographics
NPI:1598707887
Name:ZLOTINA, ALLA (OD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:ZLOTINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 ELTINGVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2447
Mailing Address - Country:US
Mailing Address - Phone:917-554-1765
Mailing Address - Fax:
Practice Address - Street 1:3511 QUENTIN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4230
Practice Address - Country:US
Practice Address - Phone:718-377-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69794122Medicare UPIN
NYC313G1Medicare ID - Type Unspecified