Healthcare Provider Details

I. General information

NPI: 1770580938
Provider Name (Legal Business Name): EDWARD JOSEPH ZAJKOWSKI M.D.,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 CEDAR LN
TEANECK NJ
07666-4301
US

IV. Provider business mailing address

393 LYNN ST
HARRINGTON PARK NJ
07640-1119
US

V. Phone/Fax

Practice location:
  • Phone: 201-836-7171
  • Fax: 201-928-4227
Mailing address:
  • Phone: 201-767-0364
  • Fax: 201-928-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA05005100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10668020
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH
# 2
Identifier0564401
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: