Healthcare Provider Details

I. General information

NPI: 1215249560
Provider Name (Legal Business Name): JARRED CORY ZUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FIRST AVENUE NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016
US

IV. Provider business mailing address

550 FIRST AVENUE NYU LANGONE MEDICAL CENTER
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone: 212-263-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number272808
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number244974
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: