1275565269 NPI number — DR JOEL N. ZABA LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275565269 NPI number — DR JOEL N. ZABA LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOEL N. ZABA LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR JOEL N. ZABA LTD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275565269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1232 W LITTLE CREEK RD
Provider Second Line Business Mailing Address:
# 200
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23505-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-489-9656
Provider Business Mailing Address Fax Number:
757-423-4903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
281 INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
PEMBROKE ONE #105
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-497-9575
Provider Business Practice Location Address Fax Number:
757-497-1292
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZABA
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-497-9575

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  0618000449 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009235531 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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