Provider Demographics
NPI:1013264159
Name:ZWICK, HENRY PATRICK
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:PATRICK
Last Name:ZWICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NILES AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2343
Mailing Address - Country:US
Mailing Address - Phone:973-377-0052
Mailing Address - Fax:
Practice Address - Street 1:32 NILES AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2343
Practice Address - Country:US
Practice Address - Phone:973-377-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02096100183500000X
NY0551761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist