Provider Demographics
NPI:1780985929
Name:THEODORE G. ZALESKI, M.D., PA
Entity type:Organization
Organization Name:THEODORE G. ZALESKI, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-840-0446
Mailing Address - Street 1:212 JACK MARTIN BLVD
Mailing Address - Street 2:STE. D2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7771
Mailing Address - Country:US
Mailing Address - Phone:732-840-0446
Mailing Address - Fax:732-840-0491
Practice Address - Street 1:212 JACK MARTIN BLVD
Practice Address - Street 2:STE. D2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7771
Practice Address - Country:US
Practice Address - Phone:732-840-0446
Practice Address - Fax:732-840-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12558Medicare UPIN
005868Medicare PIN