Provider Demographics
NPI:1699985648
Name:ZEITLIN, ROBERT ELLIOT (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIOT
Last Name:ZEITLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 VOORHIES AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3959
Mailing Address - Country:US
Mailing Address - Phone:718-332-1778
Mailing Address - Fax:718-332-5816
Practice Address - Street 1:1603 VOORHIES AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3959
Practice Address - Country:US
Practice Address - Phone:718-332-1778
Practice Address - Fax:718-332-5816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00396323Medicaid
NY00396323Medicaid
NYT49487Medicare UPIN