Provider Demographics
NPI:1982916284
Name:UMDNJSOM
Entity Type:Organization
Organization Name:UMDNJSOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-725-6750
Mailing Address - Street 1:401 E ATLANTIC AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1740
Mailing Address - Country:US
Mailing Address - Phone:717-725-6750
Mailing Address - Fax:
Practice Address - Street 1:401 E ATLANTIC AVE APT 323
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1740
Practice Address - Country:US
Practice Address - Phone:717-725-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty