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General NPI Number Information
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NPI Number | 1639405384
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Entity Type | Organization
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Legal Business Name | JOHN P. ZINCONE, M.D. PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 54 MAIN ST SUITE 101
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1400
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Country | US
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Telephone | 973-214-0508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93
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City | LEDGEWOOD
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State | NJ
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Zip | 07852-0093
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Country | US
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Telephone | 973-214-0508
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. JOHN P. ZINCONE
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Credential | M.D.
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Telephone | 973-214-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 25MA07758300
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License Number State | NJ
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