Healthcare Provider Details

I. General information

NPI: 1649086570
Provider Name (Legal Business Name): JESSE DANIEL ZUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JOURNAL SQUARE SUITE 505
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

26 JOURNAL SQUARE SUITE 505
JERSEY CITY NJ
07306
US

V. Phone/Fax

Practice location:
  • Phone: 201-212-6475
  • Fax:
Mailing address:
  • Phone: 201-212-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: