Provider Demographics
NPI:1073581419
Name:ZIEGLER, BRENDA LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LESLIE
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1706
Mailing Address - Country:US
Mailing Address - Phone:973-627-3576
Mailing Address - Fax:
Practice Address - Street 1:333 MOUNT HOPE AVE
Practice Address - Street 2:ROCKAWAY FAMILY MEDICINE ASSOCIATES
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1645
Practice Address - Country:US
Practice Address - Phone:973-895-6601
Practice Address - Fax:973-895-5324
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06311200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07549Medicare UPIN
032909Medicare PIN