Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 008919 | CT |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 021286-1 | NY |
NPI | 1083681597 |
---|---|
Provider Name | Dr. Malcolm Baldwin Zola |
First Address | Bronx, NY 10457 |
Second Address | The Bronx, New York, NY 10457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00421412 | (05) | NY |
T49682 | (02) | NY |