Healthcare Provider Details

I. General information

NPI: 1457425928
Provider Name (Legal Business Name): DANIEL ZYKORIE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 IRON BRIDGE RD SUITE 15
FREEHOLD NJ
07728-5304
US

IV. Provider business mailing address

501 IRON BRIDGE RD SUITE 15
FREEHOLD NJ
07728-5304
US

V. Phone/Fax

Practice location:
  • Phone: 732-866-8611
  • Fax: 732-303-1221
Mailing address:
  • Phone: 732-866-8611
  • Fax: 732-303-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05212500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: