Provider Demographics
NPI:1720047442
Name:ZELAZNICKA, JOLANTA (MD)
Entity type:Individual
Prefix:MISS
First Name:JOLANTA
Middle Name:
Last Name:ZELAZNICKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOLANTA
Other - Middle Name:
Other - Last Name:ZELAZNICKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:41 CORPORATE DRIVE
Mailing Address - Street 2:STE 102
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2661
Mailing Address - Country:US
Mailing Address - Phone:610-252-0515
Mailing Address - Fax:610-252-2130
Practice Address - Street 1:41 CORPORATE DRIVE
Practice Address - Street 2:STE 102
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2661
Practice Address - Country:US
Practice Address - Phone:610-252-0515
Practice Address - Fax:610-252-2130
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052969L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01587837Medicaid
PA5734199OtherAETNA
PA876169OtherBS & KEYSTONE
G28717Medicare UPIN
PA5734199OtherAETNA