Provider Demographics
NPI:1285836296
Name:YAQUB, ZUNERA (MD)
Entity Type:Individual
Prefix:
First Name:ZUNERA
Middle Name:
Last Name:YAQUB
Suffix:
Gender:F
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:PO BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:976-290-7495
Practice Address - Street 1:350 MAIN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9222
Practice Address - Country:US
Practice Address - Phone:973-657-8220
Practice Address - Fax:973-402-4806
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08858100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ228370Medicare PIN