Healthcare Provider Details

I. General information

NPI: 1881131910
Provider Name (Legal Business Name): MICHAEL ZUCKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 NORTHERN BLVD STE 200
GREAT NECK NY
11021
US

IV. Provider business mailing address

611 NORTHERN BLVD STE 200
GREAT NECK NY
11021-5208
US

V. Phone/Fax

Practice location:
  • Phone: 516-723-2663
  • Fax:
Mailing address:
  • Phone: 516-723-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number020569
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: