Provider Demographics
NPI:1578901393
Name:ZUCKER BAUCKHAM, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ZUCKER BAUCKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 SAW MILL RIVER ROAD
Mailing Address - Street 2:HTA OF NEW YORK
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-674-0733
Mailing Address - Fax:914-674-0285
Practice Address - Street 1:1053 SAW MILL RIVER ROAD
Practice Address - Street 2:HTA OF NEW YORK
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-674-0733
Practice Address - Fax:914-674-0285
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator