Provider Demographics
NPI:1386745578
Name:ZEITLIN, ADAM D (DO)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:D
Last Name:ZEITLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13666 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2328
Mailing Address - Country:US
Mailing Address - Phone:718-380-3809
Mailing Address - Fax:718-303-8240
Practice Address - Street 1:7161 159TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-4123
Practice Address - Country:US
Practice Address - Phone:718-380-3809
Practice Address - Fax:718-303-8240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02586547Medicaid
NY06219Medicare ID - Type UnspecifiedGHI MEDICARE
NYI02784Medicare UPIN
NY02586547Medicaid