Provider Demographics
NPI:1457371957
Name:ZEITELS, JERROLD R (MD)
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:R
Last Name:ZEITELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 105 BLDG. A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3570
Mailing Address - Country:US
Mailing Address - Phone:908-654-6540
Mailing Address - Fax:908-654-6504
Practice Address - Street 1:955 S SPRINGFIELD AVE
Practice Address - Street 2:SUITE 105 BLDG. A
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3570
Practice Address - Country:US
Practice Address - Phone:908-654-6540
Practice Address - Fax:908-654-6504
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04979000208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0977209Medicaid
C56962Medicare UPIN
NJ0977209Medicaid