Provider Demographics
NPI:1174513345
Name:ZATHURECZKY, IZABELLA K (MD)
Entity type:Individual
Prefix:
First Name:IZABELLA
Middle Name:K
Last Name:ZATHURECZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 4 SUITE K
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-895-8103
Mailing Address - Fax:609-895-8105
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BUILDING 4 SUITE K
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-895-8103
Practice Address - Fax:609-895-8105
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA54883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5055903Medicaid
2A689084Medicare ID - Type Unspecified
NJ5055903Medicaid