Healthcare Provider Details

I. General information

NPI: 1679505002
Provider Name (Legal Business Name): ZINOVY KOZLOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 E HAZELWOOD AVE
RAHWAY NJ
07065-5818
US

IV. Provider business mailing address

15 LAURA LN
MORRISTOWN NJ
07960-6426
US

V. Phone/Fax

Practice location:
  • Phone: 732-381-3636
  • Fax: 732-381-5977
Mailing address:
  • Phone: 973-539-0225
  • Fax: 732-381-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMA-048011
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: