Provider Demographics
NPI:1952316226
Name:PHYSICIAN SHOCKWAVER THERAPY
Entity Type:Organization
Organization Name:PHYSICIAN SHOCKWAVER THERAPY
Other - Org Name:EXCELLENCE SHOCKWAVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-848-3338
Mailing Address - Street 1:13 WEST AVE
Mailing Address - Street 2:PO BOX 145
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-0145
Mailing Address - Country:US
Mailing Address - Phone:856-769-8270
Mailing Address - Fax:856-769-8275
Practice Address - Street 1:13 WEST AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-0145
Practice Address - Country:US
Practice Address - Phone:856-769-8270
Practice Address - Fax:856-769-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment