Healthcare Provider Details

I. General information

NPI: 1669547220
Provider Name (Legal Business Name): JOSEPH STEPHEN ZUCKER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 LEXINGTON AVE 3W
NEW YORK NY
10128-2543
US

IV. Provider business mailing address

1449 LEXINGTON AVE APT 3W
NEW YORK NY
10128-2543
US

V. Phone/Fax

Practice location:
  • Phone: 212-628-1330
  • Fax: 212-722-8513
Mailing address:
  • Phone: 212-628-1330
  • Fax: 212-722-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: