Healthcare Provider Details

I. General information

NPI: 1063441673
Provider Name (Legal Business Name): DARRYL ZUCKERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510
US

IV. Provider business mailing address

PO BOX 208042
NEW HAVEN CT
06520-8042
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-1010
  • Fax:
Mailing address:
  • Phone: 203-785-5253
  • Fax: 203-785-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2008014593
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2008014593
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number63767
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: