Provider Demographics
NPI:1487657094
Name:ZUCCALA, SCOTT JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JEFFREY
Last Name:ZUCCALA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:240 RED TAIL RD
Mailing Address - Street 2:SUITE 1&2
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1581
Mailing Address - Country:US
Mailing Address - Phone:716-649-6500
Mailing Address - Fax:716-649-0031
Practice Address - Street 1:240 RED TAIL RD
Practice Address - Street 2:SUITE 1&2
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1581
Practice Address - Country:US
Practice Address - Phone:716-649-6500
Practice Address - Fax:716-649-0031
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1957851207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161019149OtherFIDELIS
NY01519662Medicaid
NY161019149OtherAETNA
NY404328OtherWELLCARE
NY161019149OtherNOVA
NY0709665OtherINDEPENDENT HEALTH
NY161019149OtherUNITED HEALTH CARE
NY10195001OtherUNIVERA
NY005236375OtherCOMMUNITY BLUE
NY161019149OtherEMPIRE
NY161019149OtherFIDELIS
NY161019149OtherUNITED HEALTH CARE