Provider Demographics
NPI:1013524917
Name:LEONID G ZOLOTNITSKIY MD PC
Entity Type:Organization
Organization Name:LEONID G ZOLOTNITSKIY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYSHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-650-0027
Mailing Address - Street 1:100 ROSEMARY WAY APT 312
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1222
Mailing Address - Country:US
Mailing Address - Phone:617-378-1344
Mailing Address - Fax:
Practice Address - Street 1:1853 COMMONWEALTH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5498
Practice Address - Country:US
Practice Address - Phone:617-378-1344
Practice Address - Fax:617-699-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health