Provider Demographics
NPI:1336231208
Name:ZUKLIE, BRANDON MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:ZUKLIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5523
Mailing Address - Country:US
Mailing Address - Phone:732-699-1900
Mailing Address - Fax:732-699-1901
Practice Address - Street 1:2 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5523
Practice Address - Country:US
Practice Address - Phone:732-699-1900
Practice Address - Fax:732-699-1901
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00265700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8583706Medicaid
077374Medicare ID - Type Unspecified
NJ8583706Medicaid
NJ5012850001Medicare NSC
NJ6314830001Medicare NSC