Healthcare Provider Details

I. General information

NPI: 1487948113
Provider Name (Legal Business Name): NATHAN J ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2011
Last Update Date: 05/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WYCHWOOD LN
LANGHORNE PA
19047-1680
US

IV. Provider business mailing address

5 WYCHWOOD LN
LANGHORNE PA
19047-1680
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-7541
  • Fax: 215-750-7542
Mailing address:
  • Phone: 215-750-7541
  • Fax: 215-750-7542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD12690E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: