MEDICARE: MS. DEBRA ZUCCHERO MS ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1003434	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174400000X	OTHER	NY	SPECIALIST

General Provider Information

NPI Number	:	1114351657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA ZUCCHERO MS ED

Provider Business Mailing Address
First Line	:	305 OLD COUNTRY RD
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-2024
Country	:	US
Telephone Number	:	631-617-3029
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 OLD COUNTRY RD
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-2024
Country	:	US
Telephone Number	:	631-617-3029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2013
Last Update Date	:	08/31/2013

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