Provider Demographics
NPI:1699890830
Name:ZODIATIS, PARAS JAYANT (DO)
Entity type:Individual
Prefix:
First Name:PARAS
Middle Name:JAYANT
Last Name:ZODIATIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PARAS
Other - Middle Name:JAYANT
Other - Last Name:ZAVERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2323
Practice Address - Fax:973-977-9455
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08208500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0139483Medicaid
NJ114380YU0MMedicare PIN