MEDICARE: DR. MALCOLM BALDWIN ZOLA D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	021286-1	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	008919	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083681597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALCOLM BALDWIN ZOLA D.D.S.

Provider Business Mailing Address
First Line	:	ST BARNABAS HOSPITAL
Second Line	:	4422 THIRD AVENUE; MILLS BUILDING, DENTAL DEPARTMENT
City	:	BRONX
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	718-960-9413
Fax Number	:	718-960-3663

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF DENTISTRY; ST BARNABAS HOSPITAL
Second Line	:	4422 THIRD AVENUE;
City	:	THE BRONX, NEW YORK
State	:	NY
Zip	:	10457
Country	:	US
Telephone Number	:	718-960-9413
Fax Number	:	718-960-3663

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/23/2007

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Directions to “ DR. MALCOLM BALDWIN ZOLA D.D.S.” Practice Location

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