Healthcare Provider Details

I. General information

NPI: 1417616194
Provider Name (Legal Business Name): BETH LYNN ZUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-98 MANHATTAN AVENUE
BROOKLYN NY
11206-2505
US

IV. Provider business mailing address

60 MADISON AVENUE 5TH FLOOR
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-388-0390
  • Fax: 718-486-5741
Mailing address:
  • Phone: 212-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF310554-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: