Healthcare Provider Details

I. General information

NPI: 1962758219
Provider Name (Legal Business Name): MRS. BARBRA G ZUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 W WAUKENA AVE
OCEANSIDE NY
11572-5050
US

IV. Provider business mailing address

178 W WAUKENA AVE
OCEANSIDE NY
11572-5050
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-5047
  • Fax:
Mailing address:
  • Phone: 516-536-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: