Healthcare Provider Details

I. General information

NPI: 1619653235
Provider Name (Legal Business Name): DR. TERRY ZICKERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CENTRAL AVENUE, SUITE 311
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

50 CUMMINGS CIR
WEST ORANGE NJ
07052-2267
US

V. Phone/Fax

Practice location:
  • Phone: 862-520-1920
  • Fax:
Mailing address:
  • Phone: 917-612-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00612700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: