Provider Demographics
NPI:1184492043
Name:ZADERA, DOMINICK MICHAEL
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:MICHAEL
Last Name:ZADERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 LAKEWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2243
Mailing Address - Country:US
Mailing Address - Phone:732-736-6559
Mailing Address - Fax:
Practice Address - Street 1:1198 LAKEWOOD RD STE 102
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2243
Practice Address - Country:US
Practice Address - Phone:732-736-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)