Provider Demographics
NPI:1275817520
Name:ZUCKERMAN, JACK (DPT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1526
Mailing Address - Country:US
Mailing Address - Phone:917-939-6933
Mailing Address - Fax:718-769-8400
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1526
Practice Address - Country:US
Practice Address - Phone:973-857-1616
Practice Address - Fax:718-769-3255
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist