Provider Demographics
NPI:1144240102
Name:ZUCKERMAN, BERNARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:D
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1712
Mailing Address - Country:US
Mailing Address - Phone:203-234-6872
Mailing Address - Fax:203-234-6880
Practice Address - Street 1:140 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1712
Practice Address - Country:US
Practice Address - Phone:203-234-6872
Practice Address - Fax:203-234-6880
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83551Medicare UPIN