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General NPI Number Information
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NPI Number | 1023701919
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Entity Type | Individual
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Provider Name | ZLATA POLYAEVA CRNA, APRN
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Gender | Female
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 1 ROBERT WOOD JOHNSON PL
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1928
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Country | US
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Telephone | 732-828-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HANSON AVE
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR11236300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ14882700
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License Number State | NJ
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