1487657094 NPI number — DR. SCOTT JEFFREY ZUCCALA D.O.

Table of content: DR. SCOTT JEFFREY ZUCCALA D.O. (NPI 1487657094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487657094 NPI number — DR. SCOTT JEFFREY ZUCCALA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZUCCALA
Provider First Name:
SCOTT
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487657094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 RED TAIL RD
Provider Second Line Business Mailing Address:
SUITE 1&2
Provider Business Mailing Address City Name:
ORCHARD PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14127-1581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-649-6500
Provider Business Mailing Address Fax Number:
716-649-0031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 RED TAIL RD
Provider Second Line Business Practice Location Address:
SUITE 1&2
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-1581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-649-6500
Provider Business Practice Location Address Fax Number:
716-649-0031
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  1957851 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161019149 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01519662 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161019149 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 404328 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161019149 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0709665 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161019149 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10195001 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 005236375 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161019149 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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