Healthcare Provider Details

I. General information

NPI: 1982123915
Provider Name (Legal Business Name): SHMUEL ELIEZER ZUCKERMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ASTOR AVE
BRONX NY
10467-9304
US

IV. Provider business mailing address

750 ASTOR AVE
BRONX NY
10467-9304
US

V. Phone/Fax

Practice location:
  • Phone: 718-882-5000
  • Fax:
Mailing address:
  • Phone: 718-882-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: