Provider Demographics
NPI:1821239807
Name:JEFFREY S. ZLOTNICK OD
Entity Type:Organization
Organization Name:JEFFREY S. ZLOTNICK OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ZLOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-549-3555
Mailing Address - Street 1:39 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2277
Mailing Address - Country:US
Mailing Address - Phone:732-549-3555
Mailing Address - Fax:732-549-3595
Practice Address - Street 1:39 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2277
Practice Address - Country:US
Practice Address - Phone:732-549-3555
Practice Address - Fax:732-549-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00289000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0939200-01Medicaid
U26806Medicare UPIN
NJZL521163Medicare PIN
NJ0939200-01Medicaid