Healthcare Provider Details

I. General information

NPI: 1134046758
Provider Name (Legal Business Name): MARK ZHUKOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WOOTTON ST
BOONTON NJ
07005-1925
US

IV. Provider business mailing address

77 RUTGERS LN
PARSIPPANY NJ
07054-4225
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-1730
  • Fax: 973-299-1733
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number31TD00426800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: