Provider Demographics
NPI:1740476563
Name:MERRIAM, ZACHARY MASON (DO)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:MASON
Last Name:MERRIAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S VAN BRUNT ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4600
Mailing Address - Country:US
Mailing Address - Phone:201-659-7700
Mailing Address - Fax:
Practice Address - Street 1:401 S VAN BRUNT ST STE 301
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4600
Practice Address - Country:US
Practice Address - Phone:201-659-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050100207V00000X
NY263823207V00000X
NJ25MB09689400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0980536Medicaid