Healthcare Provider Details

I. General information

NPI: 1720581028
Provider Name (Legal Business Name): STEPHANIE L ZITANI MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442D COMMONS WAY
TOMS RIVER NJ
08755-6429
US

IV. Provider business mailing address

442D COMMONS WAY
TOMS RIVER NJ
08755-6429
US

V. Phone/Fax

Practice location:
  • Phone: 609-389-9509
  • Fax: 732-505-5308
Mailing address:
  • Phone: 609-389-9509
  • Fax: 732-505-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00278800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number120-2003804-00
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: