MEDICARE: MS. HEIDI L ZUCKERMAN M.S., C.C.C/S.L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	002410-1	NY

General Provider Information

NPI Number	:	1376722215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI L ZUCKERMAN M.S., C.C.C/S.L.P.

Provider Business Mailing Address
First Line	:	1539 ERIC LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 ERIC LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3605
Country	:	US
Telephone Number	:	516-485-7167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2007
Last Update Date	:	10/28/2007

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