Healthcare Provider Details

I. General information

NPI: 1972765451
Provider Name (Legal Business Name): STEPHEN RANDOLPH ZUKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 DENSTON DR
AMBLER PA
19002-4036
US

IV. Provider business mailing address

1012 DENSTON DR
AMBLER PA
19002-4036
US

V. Phone/Fax

Practice location:
  • Phone: 484-844-9822
  • Fax:
Mailing address:
  • Phone: 484-844-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD440776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: