Provider Demographics
NPI:1609285568
Name:ZASTROW, ALAN (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:ZASTROW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-4049
Mailing Address - Country:US
Mailing Address - Phone:732-762-7444
Mailing Address - Fax:
Practice Address - Street 1:1009 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-4049
Practice Address - Country:US
Practice Address - Phone:732-634-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00654200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist