Provider Demographics
NPI:1437128808
Name:ZELENGER, SHANDOR (OD)
Entity type:Individual
Prefix:
First Name:SHANDOR
Middle Name:
Last Name:ZELENGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3001
Mailing Address - Country:US
Mailing Address - Phone:718-265-0201
Mailing Address - Fax:212-748-1285
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 1015
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:718-265-0201
Practice Address - Fax:212-748-1285
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006017152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02010548Medicaid
NY1315940001Medicare NSC
NYC606425881Medicare PIN
NYU77821Medicare UPIN
NYG400009661Medicare PIN
NYC60641Medicare PIN