MEDICARE: DR. PERRY PHILIP ZUCKERMAN MD

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	G55101	CA

General Provider Information

NPI Number	:	1912097676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY PHILIP ZUCKERMAN MD

Provider Business Mailing Address
First Line	:	12044 TURTLE SPRINGS LN
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-3836
Country	:	US
Telephone Number	:	818-831-7859
Fax Number	:	818-831-9439

Provider Business Practice Location Address
First Line	:	12044 TURTLE SPRINGS LN
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-3836
Country	:	US
Telephone Number	:	818-831-7859
Fax Number	:	818-831-9439

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	09/25/2007

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