Healthcare Provider Details

I. General information

NPI: 1548598758
Provider Name (Legal Business Name): A NDREA ZUCKERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2009
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W SHORE DR
PUTNAM VALLEY NY
10579-1930
US

IV. Provider business mailing address

90 W SHORE DR
PUTNAM VALLEY NY
10579-1930
US

V. Phone/Fax

Practice location:
  • Phone: 914-672-2806
  • Fax:
Mailing address:
  • Phone: 914-219-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number165863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: