Healthcare Provider Details

I. General information

NPI: 1184492043
Provider Name (Legal Business Name): DOMINICK MICHAEL ZADERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2243
US

IV. Provider business mailing address

1198 LAKEWOOD RD STE 102
TOMS RIVER NJ
08753-2243
US

V. Phone/Fax

Practice location:
  • Phone: 732-736-6559
  • Fax:
Mailing address:
  • Phone: 732-736-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: