Healthcare Provider Details

I. General information

NPI: 1467474536
Provider Name (Legal Business Name): KAREN SUE ZIEMKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 NORTHFIELD AVENUE SUITE 4
WEST ORANGE NJ
07052-1144
US

IV. Provider business mailing address

745 NORTHFIELD AVENUE SUITE 4
WEST ORANGE NJ
07052-1144
US

V. Phone/Fax

Practice location:
  • Phone: 973-716-0041
  • Fax: 973-716-0042
Mailing address:
  • Phone: 973-736-0041
  • Fax: 973-736-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA60442
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: