1598909780 NPI number — MARK J. ZUCKERMAN, PHYSICIAN, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598909780 NPI number — MARK J. ZUCKERMAN, PHYSICIAN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK J. ZUCKERMAN, PHYSICIAN, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1598909780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 ROUTE 111
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-360-3366
Provider Business Mailing Address Fax Number:
631-360-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 ROUTE 111
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-4756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-360-3366
Provider Business Practice Location Address Fax Number:
631-360-3380
Provider Enumeration Date:
05/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZUCKERMAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
631-360-3366

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  171222 , 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)





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