=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184659237
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAACOV B ZAMEL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 01/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 RIVER AVE UNIT 10
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-775-0222
-----------------------------------------------------
Fax | 732-775-0224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 RIVER AVE UNIT 10
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-775-0222
-----------------------------------------------------
Fax | 732-775-0224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 25MA07471300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------