Healthcare Provider Details

I. General information

NPI: 1124544267
Provider Name (Legal Business Name): ZEAL A MARTIN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERFRONT PLZ STE 300
NEWARK NJ
07102-5412
US

IV. Provider business mailing address

PO BOX 40409
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 201-273-7047
  • Fax:
Mailing address:
  • Phone: 201-273-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06305900
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: