Healthcare Provider Details

I. General information

NPI: 1134756521
Provider Name (Legal Business Name): KRISTA ANN ZACHARIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE STE 307
RIDGEWOOD NJ
07450-3937
US

IV. Provider business mailing address

1200 E RIDGEWOOD AVE STE 307
RIDGEWOOD NJ
07450-3937
US

V. Phone/Fax

Practice location:
  • Phone: 201-670-8660
  • Fax:
Mailing address:
  • Phone: 201-670-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA12938100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: