MEDICARE: DR. MICHAEL DOMINICK ZITO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	35SI00359900	NJ

General Provider Information

NPI Number	:	1730203670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DOMINICK ZITO PH.D.

Provider Business Mailing Address
First Line	:	776 MOUNTAIN BLVD STE 102
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6269
Country	:	US
Telephone Number	:	908-753-8696
Fax Number	:	908-757-2911

Provider Business Practice Location Address
First Line	:	51 SOUTH ST STE 1
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-8107
Country	:	US
Telephone Number	:	973-539-5600
Fax Number	:	908-757-2911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	06/26/2020

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