Healthcare Provider Details

I. General information

NPI: 1659520070
Provider Name (Legal Business Name): THADDEUS ZAJAC II DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ROUTE 23 STE 250
WAYNE NJ
07470-7520
US

IV. Provider business mailing address

1680 ROUTE 23 STE 250
WAYNE NJ
07470-7520
US

V. Phone/Fax

Practice location:
  • Phone: 973-633-1122
  • Fax: 973-832-7550
Mailing address:
  • Phone: 973-633-1122
  • Fax: 973-832-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00972000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: