Provider Demographics
NPI:1336126473
Name:ZAKLAMA, SELVIA (MD)
Entity Type:Individual
Prefix:
First Name:SELVIA
Middle Name:
Last Name:ZAKLAMA
Suffix:
Gender:F
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:PO BOX 51045
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5145
Mailing Address - Country:US
Mailing Address - Phone:201-945-2481
Mailing Address - Fax:201-943-8105
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-945-2481
Practice Address - Fax:201-943-8105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04476300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3944506Medicaid
NJ594508Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ3944506Medicaid