Healthcare Provider Details

I. General information

NPI: 1831246354
Provider Name (Legal Business Name): NICHOLAS ZUCCALA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BELLEMEADE AVE STE 11
SMITHTOWN NY
11787-1871
US

IV. Provider business mailing address

15 BELLEMEADE AVE STE 11
SMITHTOWN NY
11787-1871
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-2965
  • Fax: 631-724-4281
Mailing address:
  • Phone: 631-360-2965
  • Fax: 631-724-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX007251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: