Provider Demographics
NPI:1083681597
Name:ZOLA, MALCOLM BALDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:BALDWIN
Last Name:ZOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST BARNABAS HOSPITAL
Mailing Address - Street 2:4422 THIRD AVENUE; MILLS BUILDING, DENTAL DEPARTMENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-960-9413
Mailing Address - Fax:718-960-3663
Practice Address - Street 1:DEPARTMENT OF DENTISTRY; ST BARNABAS HOSPITAL
Practice Address - Street 2:4422 THIRD AVENUE;
Practice Address - City:THE BRONX, NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-9413
Practice Address - Fax:718-960-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021286-11223S0112X
CT0089191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00421412Medicaid
NY00421412Medicaid
NYT49682Medicare UPIN