Healthcare Provider Details

I. General information

NPI: 1649250440
Provider Name (Legal Business Name): BARRY ALAN ZICHERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579A CRANBURY RD UNIVERSITY RADIOLOGY GROUP PC
EAST BRUNSWICK NJ
08816
US

IV. Provider business mailing address

579A CRANBURY RD UNIVERSITY RADIOLOGY GROUP PC
EAST BRUNSWICK NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-0040
  • Fax: 732-390-1856
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-390-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD471810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA02386700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: