Provider Demographics
NPI:1093455909
Name:ZITRIN, REBECCA BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BETH
Last Name:ZITRIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 BOWSPRIT PT
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2705
Mailing Address - Country:US
Mailing Address - Phone:732-773-3930
Mailing Address - Fax:
Practice Address - Street 1:465 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2157
Practice Address - Country:US
Practice Address - Phone:856-332-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00693900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics