Healthcare Provider Details

I. General information

NPI: 1174672463
Provider Name (Legal Business Name): GARY BRUCE ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 HIGHWAY 27 SUITE 6
KENDALL PARK NJ
08824
US

IV. Provider business mailing address

32 RANDALL RD
PRINCETON NJ
08540-3610
US

V. Phone/Fax

Practice location:
  • Phone: 732-821-0595
  • Fax: 732-821-1174
Mailing address:
  • Phone: 609-430-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA60083
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number177662-1
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: