Provider Demographics
NPI:1396051488
Name:KENNETH H ZELNICK MD PA
Entity type:Organization
Organization Name:KENNETH H ZELNICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:ZELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-681-4088
Mailing Address - Street 1:4101 NW 4TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2850
Mailing Address - Country:US
Mailing Address - Phone:954-681-4088
Mailing Address - Fax:954-678-0166
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2850
Practice Address - Country:US
Practice Address - Phone:954-681-4088
Practice Address - Fax:954-678-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN