Healthcare Provider Details

I. General information

NPI: 1649588021
Provider Name (Legal Business Name): JODI B. ZUCKER-MAZER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AGREN LN
NESCONSET NY
11767-3103
US

IV. Provider business mailing address

1 AGREN LN
NESCONSET NY
11767-3103
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-8083
  • Fax:
Mailing address:
  • Phone: 631-737-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007224-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: