Provider Demographics
NPI:1164481354
Name:ZAVOTSKY, JEFFRY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:
Last Name:ZAVOTSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1838
Mailing Address - Country:US
Mailing Address - Phone:732-249-0360
Mailing Address - Fax:732-249-0035
Practice Address - Street 1:78 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1838
Practice Address - Country:US
Practice Address - Phone:732-249-0360
Practice Address - Fax:732-249-0035
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05875500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG41520Medicare UPIN
NJ011099A24Medicare ID - Type Unspecified