Healthcare Provider Details

I. General information

NPI: 1982825303
Provider Name (Legal Business Name): HEIDI NICOLE ZUCKERMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTHERN BLVD SUITE 116
GREAT NECK NY
11021-5306
US

IV. Provider business mailing address

1010 NORTHERN BLVD SUITE 116
GREAT NECK NY
11021-5306
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-5651
  • Fax:
Mailing address:
  • Phone: 516-829-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: