Provider Demographics
NPI:1144567686
Name:ZELDIS, JEROME B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:B
Last Name:ZELDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LIBRARY PL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3019
Mailing Address - Country:US
Mailing Address - Phone:732-672-5958
Mailing Address - Fax:908-673-9001
Practice Address - Street 1:151 LIBRARY PL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3019
Practice Address - Country:US
Practice Address - Phone:732-672-5958
Practice Address - Fax:908-673-9001
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65020174H00000X
NY198021-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator