Provider Demographics
NPI:1750703492
Name:WACHMAN, ZELDA (MD)
Entity type:Individual
Prefix:DR
First Name:ZELDA
Middle Name:
Last Name:WACHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZELDA GILA
Other - Middle Name:JILL
Other - Last Name:WACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JILL WACHMAN
Mailing Address - Street 1:44 CLAREMONT CT
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5418
Mailing Address - Country:US
Mailing Address - Phone:732-998-3221
Mailing Address - Fax:
Practice Address - Street 1:44 CLAREMONT CT
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5418
Practice Address - Country:US
Practice Address - Phone:732-998-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06388800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF46515Medicare UPIN