Basic Information
| Provider Information | |||||||||
| NPI: | 1356319180 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZUCKER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 LYONS AVE | ||||||||
| Address2: | SUITE L4 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071122027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739267205 | ||||||||
| FaxNumber: | 9739238993 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 ROUTE 24 STE E | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079302920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088791500 | ||||||||
| FaxNumber: | 9088791515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | NJMA45124 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0333808 | 05 | NJ | MEDICAID |