Provider Demographics
NPI:1407226939
Name:ZUCKERMAN, RIVKA LEAH (PA)
Entity Type:Individual
Prefix:
First Name:RIVKA
Middle Name:LEAH
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RIVKA
Other - Middle Name:LEAH
Other - Last Name:HORWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14439 76TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3119
Mailing Address - Country:US
Mailing Address - Phone:215-817-9597
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant