Provider Demographics
NPI:1477640456
Name:ZUCKERMAN, STUART JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:JAY
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1704
Mailing Address - Country:US
Mailing Address - Phone:212-245-8469
Mailing Address - Fax:212-586-1502
Practice Address - Street 1:883 9TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1704
Practice Address - Country:US
Practice Address - Phone:212-245-8469
Practice Address - Fax:212-586-1502
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034326OtherPHARMACY LIC #