Healthcare Provider Details

I. General information

NPI: 1144240102
Provider Name (Legal Business Name): BERNARD D ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WASHINGTON AVE
NORTH HAVEN CT
06473-1712
US

IV. Provider business mailing address

140 WASHINGTON AVE
NORTH HAVEN CT
06473-1712
US

V. Phone/Fax

Practice location:
  • Phone: 203-234-6872
  • Fax: 203-234-6880
Mailing address:
  • Phone: 203-234-6872
  • Fax: 203-234-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7946
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: