MEDICARE: SVETLANA ZONN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	MAO 72020	NJ

General Provider Information

NPI Number	:	1013948199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA ZONN MD

Provider Business Mailing Address
First Line	:	11 DAVID DR
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-3206
Country	:	US
Telephone Number	:	732-679-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 PARK AVE STE 6C
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-3015
Country	:	US
Telephone Number	:	908-755-7773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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