MEDICARE: DR. KENNETH ZIERER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	25MA5838900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417978883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ZIERER M.D.

Provider Business Mailing Address
First Line	:	1130 MCBRIDE AVE FL 3
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3806
Country	:	US
Telephone Number	:	973-812-1400
Fax Number	:	973-812-1404

Provider Business Practice Location Address
First Line	:	71 UNION AVE STE 201
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-1272
Country	:	US
Telephone Number	:	201-842-0020
Fax Number	:	201-842-0010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/09/2023

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