=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104049741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ZEMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 12/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 NORTH LIVINGSTON AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-953-8580
-----------------------------------------------------
Fax | 973-740-9362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ATTN POB 1967 29 NORTH LIVINGSTON AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-953-8580
-----------------------------------------------------
Fax | 973-740-9362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 25MA06075000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------