Healthcare Provider Details

I. General information

NPI: 1497096507
Provider Name (Legal Business Name): JACOB AARON ZUCKER B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 W COLONIAL DR
ORLANDO FL
32804-7000
US

IV. Provider business mailing address

1703 W COLONIAL DR
ORLANDO FL
32804-7000
US

V. Phone/Fax

Practice location:
  • Phone: 407-625-1843
  • Fax: 407-398-0834
Mailing address:
  • Phone: 407-625-1843
  • Fax: 407-398-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: