Provider Demographics
NPI:1336980804
Name:LOTUS LEAF MEDICAL PC
Entity type:Organization
Organization Name:LOTUS LEAF MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:ZELDICH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:267-227-1811
Mailing Address - Street 1:589 BETHLEHEM PIKE
Mailing Address - Street 2:STE 400
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936
Mailing Address - Country:US
Mailing Address - Phone:267-227-1811
Mailing Address - Fax:
Practice Address - Street 1:589 BETHLEHEM PIKE
Practice Address - Street 2:STE 400
Practice Address - City:MONTGOMERYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18936
Practice Address - Country:US
Practice Address - Phone:267-227-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty