Provider Demographics
NPI:1457565640
Name:ZELENETZ, MICHAEL IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IVAN
Last Name:ZELENETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:215 E 95TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4077
Practice Address - Country:US
Practice Address - Phone:212-996-8000
Practice Address - Fax:212-423-3127
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2019-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY237129207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02968418Medicaid
NY02968418Medicaid
NYA400003676Medicare PIN