Healthcare Provider Details

I. General information

NPI: 1912384561
Provider Name (Legal Business Name): MALKA ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COLES WAY
LAKEWOOD NJ
08701-4875
US

IV. Provider business mailing address

128 ASHLEY AVE
LAKEWOOD NJ
08701-4211
US

V. Phone/Fax

Practice location:
  • Phone: 732-523-0510
  • Fax: 732-534-7094
Mailing address:
  • Phone: 732-523-0510
  • Fax: 732-534-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: