Provider Demographics
NPI:1851537534
Name:BOLOTIN, ZHENYA E (CRNP)
Entity Type:Individual
Prefix:
First Name:ZHENYA
Middle Name:E
Last Name:BOLOTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ZHENYA
Other - Middle Name:
Other - Last Name:GRIUBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-254-2630
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:9122 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2860
Practice Address - Country:US
Practice Address - Phone:215-331-1516
Practice Address - Fax:215-331-8149
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008940363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics