Healthcare Provider Details

I. General information

NPI: 1548727605
Provider Name (Legal Business Name): ANN ZAPPULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 19TH AVE
BRICK NJ
08724-1645
US

IV. Provider business mailing address

348 19TH AVE
BRICK NJ
08724-1645
US

V. Phone/Fax

Practice location:
  • Phone: 732-619-1854
  • Fax:
Mailing address:
  • Phone: 732-619-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86062824
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: