Provider Demographics
NPI:1497096507
Name:ZUCKER, JACOB AARON (BA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:AARON
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7000
Mailing Address - Country:US
Mailing Address - Phone:407-625-1843
Mailing Address - Fax:407-398-0834
Practice Address - Street 1:1703 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7000
Practice Address - Country:US
Practice Address - Phone:407-625-1843
Practice Address - Fax:407-398-0834
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator