Healthcare Provider Details

I. General information

NPI: 1114819430
Provider Name (Legal Business Name): JONATHAN ZOMICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W PALISADE AVE # 1286
ENGLEWOOD NJ
07631-2720
US

IV. Provider business mailing address

824 FISKE ST
WOODMERE NY
11598-2404
US

V. Phone/Fax

Practice location:
  • Phone: 347-915-4157
  • Fax:
Mailing address:
  • Phone: 347-915-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number026862
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: