Provider Demographics
NPI:1316497506
Name:ZELEZNIK, VLADISLAV
Entity type:Individual
Prefix:MR
First Name:VLADISLAV
Middle Name:
Last Name:ZELEZNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 SHORE PKWY
Mailing Address - Street 2:APT.5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7240
Mailing Address - Country:US
Mailing Address - Phone:917-362-3235
Mailing Address - Fax:
Practice Address - Street 1:2121 SHORE PKWY
Practice Address - Street 2:APT.5G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7240
Practice Address - Country:US
Practice Address - Phone:917-362-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1387670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist