Provider Demographics
NPI:1215265772
Name:ZANOW, JEFFREY EVERETT
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EVERETT
Last Name:ZANOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 UNION RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1006
Mailing Address - Country:US
Mailing Address - Phone:856-304-1197
Mailing Address - Fax:856-599-0366
Practice Address - Street 1:529 UNION RD
Practice Address - Street 2:
Practice Address - City:MICKLETON
Practice Address - State:NJ
Practice Address - Zip Code:08056-1006
Practice Address - Country:US
Practice Address - Phone:856-304-1197
Practice Address - Fax:856-599-0366
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJH8424001343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)