Provider Demographics
NPI:1194772616
Name:J.R.ZAMORA,M.D.,P.A.
Entity type:Organization
Organization Name:J.R.ZAMORA,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-763-4796
Mailing Address - Street 1:129 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1012
Mailing Address - Country:US
Mailing Address - Phone:973-763-4796
Mailing Address - Fax:973-762-3509
Practice Address - Street 1:136 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3008
Practice Address - Country:US
Practice Address - Phone:201-200-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ26253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2850109Medicaid
NJ101561Medicare ID - Type UnspecifiedMEDICARE I.D.
NJ2850109Medicaid