Provider Demographics
NPI:1073520912
Name:ZANNELLA, ROBERT (DPM, FACFAS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ZANNELLA
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 STATE ROUTE 27
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1380
Mailing Address - Country:US
Mailing Address - Phone:732-821-2400
Mailing Address - Fax:732-821-2426
Practice Address - Street 1:2050 STATE ROUTE 27
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1380
Practice Address - Country:US
Practice Address - Phone:732-821-2400
Practice Address - Fax:732-821-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00231900213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4503280001Medicare NSC
NJU61112Medicare UPIN
NJ808479Medicare PIN