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General NPI Number Information
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NPI Number | 1720253578
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Entity Type | Organization
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Legal Business Name | DAVID ZUCKER MD LLC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 999 ORONOQUE LN 3RD FLOOR
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City | STRATFORD
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State | CT
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Zip | 06614-1379
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Country | US
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Telephone | 203-873-0333
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Fax | 203-873-0336
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Provider Business Mailing Address
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Address Line | 999 ORONOQUE LANE 3RD FLOOR
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City | STRATFORD
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State | CT
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Zip | 06614-1379
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Country | US
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Telephone | 203-873-0333
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Fax | 203-873-0336
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID ZUCKER
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Credential | MD
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Telephone | 203-873-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 027757
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License Number State | CT
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