Healthcare Provider Details

I. General information

NPI: 1356869564
Provider Name (Legal Business Name): SHOSHANA ZITTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 07/23/2021
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WORLDS FAIR DR
SOMERSET NJ
08873
US

IV. Provider business mailing address

220 S ADELAIDE AVE
HIGHLAND PARK NJ
08904-1658
US

V. Phone/Fax

Practice location:
  • Phone: 732-743-5437
  • Fax:
Mailing address:
  • Phone: 201-575-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10315600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: