Healthcare Provider Details

I. General information

NPI: 1801875828
Provider Name (Legal Business Name): JAMES W ZICCARDI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BETHEL RD BLDG D
SOMERS POINT NJ
08244-2172
US

IV. Provider business mailing address

408 BETHEL RD BLDG D
SOMERS POINT NJ
08244-2172
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-9010
  • Fax: 609-926-3392
Mailing address:
  • Phone: 609-926-9010
  • Fax: 609-926-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24147
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: