Provider Demographics
NPI:1891858569
Name:ZUKOFF, PAUL BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENNETT
Last Name:ZUKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LB#7550 P.O. BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:571 CENTRAL AVE STE 112
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-464-7300
Practice Address - Fax:908-464-7350
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA50066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63272Medicare UPIN
NJ1891858569Medicare PIN