Healthcare Provider Details

I. General information

NPI: 1770993248
Provider Name (Legal Business Name): SARA ZUCKERMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 ROUTE 1 N
ISELIN NJ
08830-2652
US

IV. Provider business mailing address

1589 E 12TH ST
BROOKLYN NY
11230-7101
US

V. Phone/Fax

Practice location:
  • Phone: 732-726-0011
  • Fax:
Mailing address:
  • Phone: 718-673-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP0033500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: