Healthcare Provider Details

I. General information

NPI: 1912579475
Provider Name (Legal Business Name): TAYLOR ZAVODNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1803
US

IV. Provider business mailing address

121 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1803
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-1535
  • Fax: 856-546-6565
Mailing address:
  • Phone: 856-546-1535
  • Fax: 856-546-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00114100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: