Provider Demographics
NPI:1851829188
Name:ZUKOWSKI, RONALD ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ROBERT
Last Name:ZUKOWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6546
Mailing Address - Country:US
Mailing Address - Phone:908-578-2541
Mailing Address - Fax:908-578-2541
Practice Address - Street 1:535 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-2002
Practice Address - Country:US
Practice Address - Phone:908-516-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01832400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QB00255200OtherPHYSICAL THERAPIST ASSISTANT LICENSE NUMBER