Provider Demographics
NPI:1730178674
Name:BAVLI, ZLATA G
Entity type:Individual
Prefix:
First Name:ZLATA
Middle Name:G
Last Name:BAVLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3100
Mailing Address - Country:US
Mailing Address - Phone:908-436-0100
Mailing Address - Fax:908-436-0295
Practice Address - Street 1:1000 S ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3100
Practice Address - Country:US
Practice Address - Phone:908-436-0100
Practice Address - Fax:908-436-0295
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI193951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ016622OtherDORAL
NY01597268Medicaid
NJ1094696OtherHORIZON NJ HEALTH
NJ7277601Medicaid