Healthcare Provider Details

I. General information

NPI: 1356917462
Provider Name (Legal Business Name): MICHELE S ZIC-TUCCINO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E PALISADE AVE
ENGLEWOOD CLIFFS NJ
07632-1800
US

IV. Provider business mailing address

200 VANDERBURGH AVE
RUTHERFORD NJ
07070-1832
US

V. Phone/Fax

Practice location:
  • Phone: 201-398-3064
  • Fax:
Mailing address:
  • Phone: 201-398-3064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00152000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: