Healthcare Provider Details

I. General information

NPI: 1316302474
Provider Name (Legal Business Name): NANCY ZUKOWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 VICTORIAN LN
MEDFORD NY
11763-2573
US

IV. Provider business mailing address

6 VICTORIAN LN
MEDFORD NY
11763-2573
US

V. Phone/Fax

Practice location:
  • Phone: 631-207-0335
  • Fax: 631-207-0523
Mailing address:
  • Phone: 631-207-0335
  • Fax: 631-207-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: