Provider Demographics
NPI:1629133723
Name:ZILBERMAN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ZILBERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 BOULEVARD E
Mailing Address - Street 2:SUITE #3B
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8400 BOULEVARD E
Practice Address - Street 2:SUITE #3B
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6049
Practice Address - Country:US
Practice Address - Phone:201-758-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11561101YA0400X
NJ37LC00046400101YA0400X
NY071143-11041C0700X
NJ44SC051851001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954732Medicaid
NY04275Medicare ID - Type UnspecifiedGHI
NYNC2061Medicare ID - Type Unspecified
NY01954732Medicaid