Healthcare Provider Details

I. General information

NPI: 1336172071
Provider Name (Legal Business Name): CHRISTINA ZUG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 13TH AVE
BROOKLYN NY
11228-2413
US

IV. Provider business mailing address

7701 13TH AVE
BROOKLYN NY
11228-2413
US

V. Phone/Fax

Practice location:
  • Phone: 718-232-1351
  • Fax: 718-837-5676
Mailing address:
  • Phone: 718-232-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number074669
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP48454
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077975-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: