Provider Demographics
NPI:1033387246
Name:ZUCKERMAN, MARK R (BS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 TULIP AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2706
Mailing Address - Country:US
Mailing Address - Phone:516-354-2000
Mailing Address - Fax:516-377-6697
Practice Address - Street 1:160 TULIP AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2706
Practice Address - Country:US
Practice Address - Phone:516-354-2000
Practice Address - Fax:516-377-6697
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist