Provider Demographics
NPI:1710958392
Name:DUKULY, ZWANNAH (MD)
Entity Type:Individual
Prefix:
First Name:ZWANNAH
Middle Name:
Last Name:DUKULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 HIGHWAY 35
Mailing Address - Street 2:BLDG M SUITE 101
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1918
Mailing Address - Country:US
Mailing Address - Phone:732-528-1323
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERVIEW PLZ
Practice Address - Street 2:RIVERVIEW MEDICAL CENTER DEPT OF PATHOLOGY
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1864
Practice Address - Country:US
Practice Address - Phone:732-530-2347
Practice Address - Fax:732-345-2045
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59684207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7538103Medicaid
NJDU005152Medicare ID - Type Unspecified
NJG63067Medicare UPIN