Healthcare Provider Details

I. General information

NPI: 1922640986
Provider Name (Legal Business Name): MITCHELL J ZDROIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 MINERAL POINT RD STE 15
MADISON WI
53717-1712
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 608-821-0075
  • Fax:
Mailing address:
  • Phone: 732-529-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1566-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: