Healthcare Provider Details

I. General information

NPI: 1881746808
Provider Name (Legal Business Name): PHILIP ZAVELOFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W COUNTY LINE RD
LAKEWOOD NJ
08701-1211
US

IV. Provider business mailing address

402 W COUNTY LINE RD
LAKEWOOD NJ
08701-1211
US

V. Phone/Fax

Practice location:
  • Phone: 732-534-3244
  • Fax: 732-534-3243
Mailing address:
  • Phone: 732-534-3244
  • Fax: 732-534-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number051726
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22D102785100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: