Provider Demographics
NPI:1477206571
Name:ZAMBRANA, EVAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:ZAMBRANA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 MEADOW RD APT 3205
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6202
Mailing Address - Country:US
Mailing Address - Phone:912-441-6959
Mailing Address - Fax:
Practice Address - Street 1:11 CENTRE DR
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1865
Practice Address - Country:US
Practice Address - Phone:609-924-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00387100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant