Provider Demographics
NPI:1053399493
Name:ZALESKI, THEODORE GEORGE (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:GEORGE
Last Name:ZALESKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE D2
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7711
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:SUITE D2
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7711
Practice Address - Country:US
Practice Address - Phone:732-840-0446
Practice Address - Fax:732-840-0491
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035141207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3444503Medicaid
C12558Medicare UPIN
NJ005868Medicare PIN