Healthcare Provider Details

I. General information

NPI: 1770734733
Provider Name (Legal Business Name): CHARLES W ZUCKERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 PARK AVE
NEW YORK NY
10065-7343
US

IV. Provider business mailing address

570 PARK AVE
NEW YORK NY
10065-7343
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-3905
  • Fax: 212-308-0464
Mailing address:
  • Phone: 212-758-3905
  • Fax: 212-308-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number030714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: