Provider Demographics
NPI:1225341449
Name:ZUCKER GERIATRICS INC
Entity Type:Organization
Organization Name:ZUCKER GERIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-351-6450
Mailing Address - Street 1:4255 S BUCKLEY RD # 267
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2951
Mailing Address - Country:US
Mailing Address - Phone:303-351-6450
Mailing Address - Fax:303-945-4913
Practice Address - Street 1:4255 S BUCKLEY RD # 267
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2951
Practice Address - Country:US
Practice Address - Phone:303-351-6450
Practice Address - Fax:303-945-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO257460943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA103546Medicare UPIN