Healthcare Provider Details

I. General information

NPI: 1407836976
Provider Name (Legal Business Name): EDWARD L ZUCKERMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 ALBRIGHTS LAKE RD
GREENSBURG PA
15601-6293
US

IV. Provider business mailing address

338 ALBRIGHTS LAKE RD
GREENSBURG PA
15601-6293
US

V. Phone/Fax

Practice location:
  • Phone: 724-838-9509
  • Fax:
Mailing address:
  • Phone: 724-838-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS002424L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: