Provider Demographics
NPI:1598862930
Name:NIZAM, ZEBA (MD)
Entity Type:Individual
Prefix:
First Name:ZEBA
Middle Name:
Last Name:NIZAM
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 1:225 MAY ST
Mailing Address - Street 2:STE D
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-494-0100
Mailing Address - Fax:732-494-0114
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 301
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-494-0100
Practice Address - Fax:732-494-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA6771902084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH34193Medicare UPIN
NJ046830U2CMedicare ID - Type Unspecified