Healthcare Provider Details

I. General information

NPI: 1548935513
Provider Name (Legal Business Name): ZLATKO ZUKICH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 KELLOGG RD
CORTLAND NY
13045-3113
US

IV. Provider business mailing address

28 KELLOGG RD
CORTLAND NY
13045-3113
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-6060
  • Fax: 607-208-6469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: