Provider Demographics
NPI:1811042955
Name:ZAK, MADELINE (DO)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:ZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESLEY CT
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1921
Mailing Address - Country:US
Mailing Address - Phone:201-437-0400
Mailing Address - Fax:201-437-6607
Practice Address - Street 1:839 AVENUE A
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1959
Practice Address - Country:US
Practice Address - Phone:201-437-0400
Practice Address - Fax:201-437-6607
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02799400208600000X, 207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00435800OtherMEDICARE-PTAN
NJ192293Medicare ID - Type Unspecified
NJC52776Medicare UPIN