Healthcare Provider Details

I. General information

NPI: 1043827330
Provider Name (Legal Business Name): RACHEL HOPE ZUKOSE MA, CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 GIBSON RD
GOSHEN NY
10924-6709
US

IV. Provider business mailing address

2 PINE CT
MONTGOMERY NY
12549-1526
US

V. Phone/Fax

Practice location:
  • Phone: 845-291-0100
  • Fax:
Mailing address:
  • Phone: 845-728-5154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number030032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: