Provider Demographics
NPI:1871589598
Name:ZELNICK, RONALD STUART (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:STUART
Last Name:ZELNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:3105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-575-7875
Mailing Address - Fax:561-575-5874
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:3105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-575-7875
Practice Address - Fax:561-575-5874
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57409208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063638000Medicaid
10780Medicare ID - Type Unspecified