Healthcare Provider Details

I. General information

NPI: 1316719743
Provider Name (Legal Business Name): JOSEPH JOHN ZUCCONI PTDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MEISNER AVE
STATEN ISLAND NY
10306-1236
US

IV. Provider business mailing address

25 SHADOWLAKE DR
RED BANK NJ
07701-5524
US

V. Phone/Fax

Practice location:
  • Phone: 718-989-3073
  • Fax:
Mailing address:
  • Phone: 917-623-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027094-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: