Provider Demographics
NPI:1649221987
Name:ZAMORA, JOSEFINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:
Last Name:ZAMORA
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 1:129 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1012
Mailing Address - Country:US
Mailing Address - Phone:973-763-4796
Mailing Address - Fax:973-762-3509
Practice Address - Street 1:136 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3008
Practice Address - Country:US
Practice Address - Phone:201-200-1414
Practice Address - Fax:973-762-3509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02625300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56123Medicare UPIN