Provider Demographics
NPI:1679505002
Name:KOZLOV, ZINOVY (MD)
Entity Type:Individual
Prefix:DR
First Name:ZINOVY
Middle Name:
Last Name:KOZLOV
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 1:15 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6426
Mailing Address - Country:US
Mailing Address - Phone:973-539-0225
Mailing Address - Fax:732-381-5977
Practice Address - Street 1:1044 E HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5818
Practice Address - Country:US
Practice Address - Phone:732-381-3636
Practice Address - Fax:732-381-5977
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA-0480112083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA61457Medicare UPIN