Healthcare Provider Details

I. General information

NPI: 1437552551
Provider Name (Legal Business Name): HALLIE ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HILLSIDE AVE
MILFORD CT
06460-7810
US

IV. Provider business mailing address

120 HILLSIDE AVE
MILFORD CT
06460-7810
US

V. Phone/Fax

Practice location:
  • Phone: 203-640-1795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number994
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: