Provider Demographics
NPI:1942391974
Name:ZUCKERBROD, JACQUELINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:ZUCKERBROD
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 1:4774 RTE 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3354
Mailing Address - Country:US
Mailing Address - Phone:732-363-6222
Mailing Address - Fax:732-363-9203
Practice Address - Street 1:4774 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3354
Practice Address - Country:US
Practice Address - Phone:732-363-6222
Practice Address - Fax:732-363-9203
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04929000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13226Medicare UPIN