Healthcare Provider Details

I. General information

NPI: 1942874078
Provider Name (Legal Business Name): BENJAMIN EZEKIEL ZUCHELKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 5TH AVE # NW628
PITTSBURGH PA
15213-3236
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-2212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD484547
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMT222894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: