Healthcare Provider Details

I. General information

NPI: 1033664347
Provider Name (Legal Business Name): YVETTE ZUCKERMAN SPECIAL ED TEACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVETTE BAROCAS

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 SINCLAIR AVE
STATEN ISLAND NY
10312-2730
US

IV. Provider business mailing address

491 SINCLAIR AVE
STATEN ISLAND NY
10312-2730
US

V. Phone/Fax

Practice location:
  • Phone: 347-661-5889
  • Fax:
Mailing address:
  • Phone: 347-661-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1052069161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: