Provider Demographics
NPI:1780775353
Name:ZELLNER, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3703
Mailing Address - Country:US
Mailing Address - Phone:718-748-2020
Mailing Address - Fax:718-748-0663
Practice Address - Street 1:7817 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3703
Practice Address - Country:US
Practice Address - Phone:718-748-2020
Practice Address - Fax:718-748-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00579180Medicaid
NY00579180Medicaid
NY42A631Medicare ID - Type Unspecified