Provider Demographics
NPI:1669466298
Name:ZISLIN, ELENA M (PA)
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:M
Last Name:ZISLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 TEAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2217
Mailing Address - Country:US
Mailing Address - Phone:732-616-6841
Mailing Address - Fax:
Practice Address - Street 1:1200 E RIDGEWOOD AVE STE 208
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3937
Practice Address - Country:US
Practice Address - Phone:201-444-0868
Practice Address - Fax:201-444-7363
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102887363AS0400X
NJ25MP00165100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3322ZMedicare ID - Type Unspecified
FLQ25009Medicare UPIN