Basic Information
| Provider Information | |||||||||
| NPI: | 1710958392 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DUKULY | ||||||||
| FirstName: | ZWANNAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2517 HIGHWAY 35 | ||||||||
| Address2: | BLDG M SUITE 101 | ||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087361918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325281323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 RIVERVIEW PLZ | ||||||||
| Address2: | RIVERVIEW MEDICAL CENTER DEPT OF PATHOLOGY | ||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077011864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325302347 | ||||||||
| FaxNumber: | 7323452045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 07/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MA59684 | NJ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 7538103 | 05 | NJ | MEDICAID |