Provider Demographics
NPI:1235215872
Name:ZUCKERMAN, CRAIG HOWARD (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:HOWARD
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REHABILITATION TODAY SERVICES
Mailing Address - Street 2:1010 WAYNE STREET SUITE 100
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-3550
Mailing Address - Fax:716-372-3575
Practice Address - Street 1:REHABILITATION TODAY SERVICES
Practice Address - Street 2:1010 WAYNE STREET SUITE 100
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-3550
Practice Address - Fax:716-372-3575
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00908407Medicaid
00020527902OtherUNIVERA
NY6108943OtherINDEPDENTHEALTHMEDISOURCE
NY000500802006OtherWNY BCBS
NYDD4722Medicare ID - Type Unspecified