Healthcare Provider Details

I. General information

NPI: 1487657094
Provider Name (Legal Business Name): SCOTT JEFFREY ZUCCALA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 RED TAIL RD SUITE 1&2
ORCHARD PARK NY
14127-1581
US

IV. Provider business mailing address

240 RED TAIL RD SUITE 1&2
ORCHARD PARK NY
14127-1581
US

V. Phone/Fax

Practice location:
  • Phone: 716-649-6500
  • Fax: 716-649-0031
Mailing address:
  • Phone: 716-649-6500
  • Fax: 716-649-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number1957851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: