Basic Information
Provider Information | |||||||||
NPI: | 1528098092 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZELKOVIC | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | F | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 247 ROUTE 100 | ||||||||
Address2: | SUITE 1002 | ||||||||
City: | SOMERS | ||||||||
State: | NY | ||||||||
PostalCode: | 105893231 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9149628290 | ||||||||
FaxNumber: | 9149628851 | ||||||||
Practice Location | |||||||||
Address1: | 150 WHITE PLAINS RD | ||||||||
Address2: | SUTIE 306 | ||||||||
City: | TARRYTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 105915535 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9144938628 | ||||||||
FaxNumber: | 9144938564 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 02/02/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 2319181 | NY | Y |   | Allopathic & Osteopathic Physicians | Urology |   | 2088P0231X | 2319181 | NY | N |   | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 2088P0231X | 043727 | CT | N |   | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 208800000X | 043727 | CT | N |   | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | 2579871 | 05 | NY |   | MEDICAID |