Provider Demographics
NPI:1154316123
Name:ZACCARIA, ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:ZACCARIA
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 1:180 WHITE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-530-8565
Mailing Address - Fax:732-530-4788
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-530-8565
Practice Address - Fax:732-530-4788
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0508512086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF52040Medicare UPIN
NJZA734737Medicare ID - Type UnspecifiedPROVIDER NUMBER