Healthcare Provider Details

I. General information

NPI: 1003909235
Provider Name (Legal Business Name): MICHAEL SCOTT ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 FULTON AVE
HEMPSTEAD NY
11550-4364
US

IV. Provider business mailing address

23 PINEWOOD RD
ROSLYN NY
11576-2419
US

V. Phone/Fax

Practice location:
  • Phone: 516-750-2500
  • Fax:
Mailing address:
  • Phone: 516-626-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number220106-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: