Provider Demographics
NPI:1881034874
Name:ALLA ZLOTINA OD PC
Entity Type:Organization
Organization Name:ALLA ZLOTINA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZLOTINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-554-1765
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 1:273 ELTINGVILLE BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2447
Practice Address - Country:US
Practice Address - Phone:917-554-1765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006703152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty