=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912097676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERRY PHILIP ZUCKERMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 09/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12044 TURTLE SPRINGS LN
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91326-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-831-7859
-----------------------------------------------------
Fax | 818-831-9439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12044 TURTLE SPRINGS LN
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91326-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-831-7859
-----------------------------------------------------
Fax | 818-831-9439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G55101
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------