Provider Demographics
NPI:1437329745
Name:DR. BRANDON M. ZUKLIE, LLC
Entity Type:Organization
Organization Name:DR. BRANDON M. ZUKLIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZUKLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-699-1900
Mailing Address - Street 1:2 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5523
Mailing Address - Country:US
Mailing Address - Phone:732-699-1900
Mailing Address - Fax:
Practice Address - Street 1:2 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5523
Practice Address - Country:US
Practice Address - Phone:732-699-1900
Practice Address - Fax:732-699-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5012850001Medicare NSC
6314830001Medicare NSC