Provider Demographics
NPI:1538327705
Name:ZEEMAN, ROGER DAVID
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DAVID
Last Name:ZEEMAN
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 1:1500 PALISADE AVENUE
Mailing Address - Street 2:8B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5313
Mailing Address - Country:US
Mailing Address - Phone:201-482-8685
Mailing Address - Fax:
Practice Address - Street 1:1500 PALISADE AVE
Practice Address - Street 2:8B
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5337
Practice Address - Country:US
Practice Address - Phone:201-482-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00172100103T00000X
NY016817103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent