Healthcare Provider Details

I. General information

NPI: 1598840555
Provider Name (Legal Business Name): TRACY ANN ZUKOWSKI MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 MAIN ST
WOODBRIDGE NJ
07095-1104
US

IV. Provider business mailing address

11 EAGLE ROCK AVE STE 201
EAST HANOVER NJ
07936-3167
US

V. Phone/Fax

Practice location:
  • Phone: 732-636-5151
  • Fax:
Mailing address:
  • Phone: 732-340-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00523800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: