Healthcare Provider Details

I. General information

NPI: 1427278225
Provider Name (Legal Business Name): DONALD E ZUEHLKE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W 110TH ST APT 4
NEW YORK NY
10026-4167
US

IV. Provider business mailing address

217 W 110TH ST APT 4
NEW YORK NY
10026-4167
US

V. Phone/Fax

Practice location:
  • Phone: 212-864-2159
  • Fax:
Mailing address:
  • Phone: 212-864-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075212-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: