Provider Demographics
NPI:1689819666
Name:ZLOTNIK, GABRIELLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:
Last Name:ZLOTNIK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 72ND ST
Mailing Address - Street 2:APT. 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3305
Mailing Address - Country:US
Mailing Address - Phone:917-647-3938
Mailing Address - Fax:
Practice Address - Street 1:214 W 29TH ST
Practice Address - Street 2:SUITE 901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5203
Practice Address - Country:US
Practice Address - Phone:917-647-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003959171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist