Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DI18372 | NJ |
NPI | 1154409571 |
---|---|
Provider Name | Dr. Scott Louis Zirkin |
First Address | Manalapan, NJ 07726-8875 |
Second Address | Sea Girt, NJ 08750-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |