MEDICARE: DAVID ZUCKER MD LLC

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	2084P0800X	Psychiatry Physician	027757	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D100000095	OTHER	CT	MEDICARE PTAN

General Provider Information

NPI Number	:	1720253578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID ZUCKER MD LLC

Provider Business Mailing Address
First Line	:	999 ORONOQUE LANE
Second Line	:	3RD FLOOR
City	:	STRATFORD
State	:	CT
Zip	:	06614-1379
Country	:	US
Telephone Number	:	203-873-0333
Fax Number	:	203-873-0336

Provider Business Practice Location Address
First Line	:	999 ORONOQUE LN
Second Line	:	3RD FLOOR
City	:	STRATFORD
State	:	CT
Zip	:	06614-1379
Country	:	US
Telephone Number	:	203-873-0333
Fax Number	:	203-873-0336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID ZUCKER
Credential	:	MD
Telephone Number	:	203-873-0333

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	02/27/2012

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Directions to “DAVID ZUCKER MD LLC ” Practice Location

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