Healthcare Provider Details

I. General information

NPI: 1457307464
Provider Name (Legal Business Name): MONIB A. ZIRVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DIAMOND HILL RD SUMMIT MEDICAL GROUP
BERKELEY HEIGHTS NJ
07922-2104
US

IV. Provider business mailing address

1 DIAMOND HILL RD SUMMIT MEDICAL GROUP
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-4300
  • Fax: 908-769-2512
Mailing address:
  • Phone: 908-273-4300
  • Fax: 908-769-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA07553400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: