Healthcare Provider Details

I. General information

NPI: 1932112489
Provider Name (Legal Business Name): IVAN S ZOOK MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 RUTHERFORD ST
HARRISBURG PA
17111-1851
US

IV. Provider business mailing address

3400 RUTHERFORD ST
HARRISBURG PA
17111-1851
US

V. Phone/Fax

Practice location:
  • Phone: 717-564-2203
  • Fax: 717-909-5182
Mailing address:
  • Phone: 717-564-2203
  • Fax: 717-909-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007029
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: