Healthcare Provider Details

I. General information

NPI: 1730367202
Provider Name (Legal Business Name): DR. BRANDON M. ZUKLIE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MITCHELL AVE
PISCATAWAY NJ
08854-5523
US

IV. Provider business mailing address

2 MITCHELL AVE
PISCATAWAY NJ
08854-5523
US

V. Phone/Fax

Practice location:
  • Phone: 732-699-1900
  • Fax: 732-699-1901
Mailing address:
  • Phone: 732-699-1900
  • Fax: 732-699-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00265700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MD00265700
License Number StateNJ

VIII. Authorized Official

Name: DR. BRANDON M ZUKLIE
Title or Position: OWNER
Credential: DPM
Phone: 732-699-1900