Provider Demographics
NPI:1306888086
Name:ZELEZNIK, JOMARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOMARIE
Middle Name:
Last Name:ZELEZNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 GRAND CONCOURSE
Mailing Address - Street 2:#BA
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1008
Mailing Address - Country:US
Mailing Address - Phone:718-561-0041
Mailing Address - Fax:
Practice Address - Street 1:3224 GRAND CONCOURSE
Practice Address - Street 2:#BA
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1008
Practice Address - Country:US
Practice Address - Phone:718-561-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185701207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01551422Medicaid
2H2720Medicare PIN
NYF70176Medicare UPIN