Provider Demographics
NPI:1396262200
Name:ZITO-GOVERT, MICHAEL STEPHEN (APN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:ZITO-GOVERT
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2325
Mailing Address - Country:US
Mailing Address - Phone:206-818-6328
Mailing Address - Fax:877-203-4369
Practice Address - Street 1:1640 ROUTE 88 WEST
Practice Address - Street 2:SUITE 203
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-458-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00754300363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty