Individual
MR. JEFFREY JOHN ZOTTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPAC
Contact information
Practice address
2184 S SHORE RD, HADLEY, NY 12835-3601
(518) 863-2749
Mailing address
PO BOX 1393, NORTHVILLE, NY 12134-1393
(518) 863-2749
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
004930
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000405762001
BLUE SHIELD NENY
NY
05
—
01563964
—
NY
Enumeration date
07/19/2006
Last updated
10/26/2012
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