Provider Demographics
NPI:1174672463
Name:ZUCKERMAN, GARY BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRUCE
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 1:32 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3610
Mailing Address - Country:US
Mailing Address - Phone:609-430-1207
Mailing Address - Fax:
Practice Address - Street 1:3084 HIGHWAY 27
Practice Address - Street 2:SUITE 6
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-821-0595
Practice Address - Fax:732-821-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60083207KA0200X
NJ177662-1207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02337171Medicaid
NJ02337171Medicaid
NJF74388Medicare UPIN