Provider Demographics
NPI:1831743889
Name:ZEITMAN, DOV BERISH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:DOV
Middle Name:BERISH
Last Name:ZEITMAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SERENITY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4060
Mailing Address - Country:US
Mailing Address - Phone:347-661-0751
Mailing Address - Fax:
Practice Address - Street 1:30 SERENITY WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4060
Practice Address - Country:US
Practice Address - Phone:347-661-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00548900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant