Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 JOURNAL SQUARE SUITE 505
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 201-212-6475
  • Fax:
Mailing address:
  • Phone: 732-982-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00729600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: