Healthcare Provider Details

I. General information

NPI: 1922973320
Provider Name (Legal Business Name): NICOLE ELIZABETH ZOT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 NJ-36 BUILDING C
WEST LONG BRANCH NJ
07764
US

IV. Provider business mailing address

185 NJ-36 BUILDING C
WEST LONG BRANCH NJ
07764
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-4534
  • Fax: 732-263-5213
Mailing address:
  • Phone: 732-923-4534
  • Fax: 732-263-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00946100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034185-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: