Healthcare Provider Details

I. General information

NPI: 1124055884
Provider Name (Legal Business Name): GEORGE P. ZUK JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 NORTH ST
BRISTOL CT
06010-4148
US

IV. Provider business mailing address

6 NORTH STREET P.O. BOX 1872
BRISTOL CT
06011-1872
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-0585
  • Fax: 860-585-0602
Mailing address:
  • Phone: 860-585-0585
  • Fax: 860-585-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: