Provider Demographics
NPI:1336204270
Name:ZUCK, KRISTINA (DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:ZUCK
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4105
Mailing Address - Country:US
Mailing Address - Phone:732-718-1765
Mailing Address - Fax:
Practice Address - Street 1:169 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4105
Practice Address - Country:US
Practice Address - Phone:732-718-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ0013800171100000X
NJ25MZ00013800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist