Provider Demographics
NPI:1790857969
Name:ZUCKMAN, ARNOLD (DPM)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:ZUCKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5302
Mailing Address - Country:US
Mailing Address - Phone:203-367-7764
Mailing Address - Fax:203-367-3556
Practice Address - Street 1:2566 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5302
Practice Address - Country:US
Practice Address - Phone:203-367-7764
Practice Address - Fax:203-367-3556
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00232213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT568061OtherAETNA
CT1803438002OtherCIGNA
CTZS616OtherOXFORD
CT030000232CT01OtherBLUE SHIELD
CT060874388OtherFEDERAL TAX ID
CT004006763Medicaid
CT27-01372OtherEVERCARE
480000368Medicare PIN
CT568061OtherAETNA