Provider Demographics
NPI:1538143425
Name:ZEEVALK, ROBERT LOCKE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOCKE
Last Name:ZEEVALK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RICHARD TER
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6208
Mailing Address - Country:US
Mailing Address - Phone:732-530-0169
Mailing Address - Fax:
Practice Address - Street 1:1029 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3181
Practice Address - Country:US
Practice Address - Phone:732-544-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD1095213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45516Medicare UPIN
NJ456323Medicare ID - Type Unspecified