Provider Demographics
NPI:1679664007
Name:OLMO-DURHAM, ZAIDA E (MD)
Entity Type:Individual
Prefix:
First Name:ZAIDA
Middle Name:E
Last Name:OLMO-DURHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZAIDA
Other - Middle Name:E
Other - Last Name:OLMO ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8534
Mailing Address - Fax:732-220-8595
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-845-9534
Practice Address - Fax:732-220-8595
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04593800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7363206Medicaid
NJ7363206Medicaid
NJOL000355Medicare ID - Type Unspecified