Provider Demographics
NPI:1275565269
Name:DR JOEL N. ZABA LTD
Entity Type:Organization
Organization Name:DR JOEL N. ZABA LTD
Other - Org Name:DR JOEL N. ZABA LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZABA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-497-9575
Mailing Address - Street 1:1232 W LITTLE CREEK RD
Mailing Address - Street 2:# 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-1952
Mailing Address - Country:US
Mailing Address - Phone:757-489-9656
Mailing Address - Fax:757-423-4903
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:PEMBROKE ONE #105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-497-9575
Practice Address - Fax:757-497-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000449302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009235531Medicaid
VA1071960001Medicare NSC
VAC03627Medicare PIN