Healthcare Provider Details

I. General information

NPI: 1073581419
Provider Name (Legal Business Name): BRENDA LESLIE ZIEGLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MOUNT HOPE AVE ROCKAWAY FAMILY MEDICINE ASSOCIATES
ROCKAWAY NJ
07866-1645
US

IV. Provider business mailing address

4 ONEIDA AVE
ROCKAWAY NJ
07866-1706
US

V. Phone/Fax

Practice location:
  • Phone: 973-895-6601
  • Fax: 973-895-5324
Mailing address:
  • Phone: 973-627-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06311200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: