MEDICARE: ZACKARY PAUL MULLEN

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	207KA0200X	Allergy Physician	25MP00985500	NJ

General Provider Information

NPI Number	:	1912860198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACKARY PAUL MULLEN

Provider Business Mailing Address
First Line	:	1023 COURTNEY WAY
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-6332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 TILTON RD STE 5
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1270
Country	:	US
Telephone Number	:	609-400-3910
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ ZACKARY PAUL MULLEN ” Practice Location

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