Provider Demographics
NPI:1881689610
Name:ZLOTNICK, JEFFREY STEVEN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:ZLOTNICK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2640
Mailing Address - Country:US
Mailing Address - Phone:732-742-1954
Mailing Address - Fax:732-549-3259
Practice Address - Street 1:5 DEVON RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2640
Practice Address - Country:US
Practice Address - Phone:732-742-1954
Practice Address - Fax:732-549-3259
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27 OM 00012400152W00000X
NJ27 OA 00289000152WC0802X, 152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ226222938OtherFEDERAL ID #
NJ0939200-01Medicaid
NJP822470OtherOXFORD #
NJ48557OtherAETNA #
NJU26806Medicare UPIN
NJ0939200-01Medicaid
NJ0170350001Medicare NSC