Healthcare Provider Details

I. General information

NPI: 1912097676
Provider Name (Legal Business Name): PERRY PHILIP ZUCKERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12044 TURTLE SPRINGS LN
NORTHRIDGE CA
91326-3836
US

IV. Provider business mailing address

12044 TURTLE SPRINGS LN
NORTHRIDGE CA
91326-3836
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-7859
  • Fax: 818-831-9439
Mailing address:
  • Phone: 818-831-7859
  • Fax: 818-831-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG55101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: