Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA11041800 | NJ |
N | 207Q00000X | Family Doctor | MD468088 | PA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 25MA11041800 | NJ |
NPI | 1639602576 |
---|---|
Provider Name | Zachary Klock |
First Address | Mount Laurel, NJ 08054-1108 |
Second Address | Mount Laurel, NJ 08054-1108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 01/09/2021 |