Basic Information
| Provider Information | |||||||||
| NPI: | 1356913883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMARRA | ||||||||
| FirstName: | NIKOLETTE | ||||||||
| MiddleName: | PATRICE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 RIVERSIDE DR N | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087241806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086708914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077282537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323084202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2021 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 1172590 | NJ | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 363A00000X | 25MP00643200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.